Medically complex pregnancies and early breastfeeding behaviors: a retrospective analysis

Predicting mothers' exclusive breastfeeding for the first 6 months: Interface creation study using machine learning technique

BACKGROUND

Machine learning techniques (MLT) build models to detect complex patterns and solve new problems using big data.

AIM

The present study aims to create a prediction interface for mothers breastfeeding exclusively for the first 6 months using MLT.

METHOD

All mothers who had babies aged 6-24 months between 15.09.2021 and 15.12.2021 and to whom the surveys could be delivered were included. 'Personal Information Form' created by the researchers was used as a data collection tool. Data from 514 mothers participating in the study were used for MLT. Data from 70% of mothers were used for educational purposes, and a prediction model was created. The data obtained from the remaining 30% of the mothers were used for testing.

RESULTS

The best MLT algorithm for predicting exclusive breastfeeding for the first 6 months was determined to be the Random Forest Classifier. The top five variables affecting the possibility of mothers breastfeeding exclusively for the first 6 months were as follows: "the mother not having any health problems during pregnancy," "there were no people who negatively affected the mother's morale about breastfeeding," "the amount of water the mother drinks in a day," "thinking that her milk supply is insufficient," "having no problems breastfeeding the baby".

CONCLUSIONS

Using created prediction model may allow early identification of mothers with a risk of not breastfeeding their babies exclusively for the first 6 months. In this way, mothers in the risk group can be closely monitored in the early period.

Breastfeeding Intention and Breastfeeding Postpartum Outcomes between High-Risk and Low-Risk Pregnant Women: A Greek Prospective Cohort Study

BACKGROUND

This prospective cohort study, conducted from pregnancy to six months postpartum and grounded in STROBE methodology, quantitatively explores the relationship between antenatal breastfeeding intentions and subsequent breastfeeding outcomes among high-risk pregnant women, compared to a low-risk pregnancy group.

METHODS

The study was conducted in one of the largest public hospitals in Attica that provides care to pregnant women, enrolling 380 participants divided into high-risk (n = 200) and low-risk (n = 180) cohorts. Data were collected over 20 months (starting from the end of May 2020 until January 2022), spanning from pregnancy to six months postpartum, via comprehensive questionnaires.

RESULTS

Statistical analysis revealed a pronounced correlation between prenatal breastfeeding intentions and actual breastfeeding behaviors across both groups. Specifically, 81.1% of women in the high-risk group and 82.5% in the low-risk group expressed intentions of exclusively breastfeeding during pregnancy. By six months postpartum, 54.9% of the high-risk and 64.3% of the low-risk pregnancy group managed to sustain breastfeeding. Extended antenatal hospitalization emerged as a statistically significant factor (p = 0.045) negatively impacting exclusive breastfeeding intentions among high-risk pregnancies.

CONCLUSION

The findings illuminate the critical influence of antenatal intentions on breastfeeding outcomes, particularly among high-risk pregnancies. Moreover, the study identifies the detrimental effect of prolonged hospital stays on breastfeeding aspirations. These insights underscore the necessity for nuanced, supportive interventions aimed at bolstering breastfeeding rates, thereby advancing maternal and neonatal health objectives aligned with World Health Organization recommendations.

Evaluating strength of recommendations for commonly administered medications in lactating women

OBJECTIVE

To characterize the data on medications for lactating people in the LactMed database and evaluate the strength of the data for the most commonly administered medications in lactating women.

METHODS

A retrospective analysis of all medications in the LactMed database in 12/2020 was performed. Each medication was classified into one of three categories: absent data, minimal-moderate data, strong data pertaining to safety in lactation. No data was defined as no available research studies associated with the medication. Minimal-moderate data was defined as absent research studies in one or more of the four LactMed categories: maternal drug levels, infant drug levels, effects on infants, effects on lactation, or if data was limited to a case report or observational study. Strong data was classified as availability of research studies in all four LactMed categories with data derived from pharmacokinetic/pharmacodynamic, cohort, case control, or randomized control studies. Additionally, the most commonly used medications in lactating women as defined by prior literature were analyzed for strength of data.

RESULTS

1408 medications were evaluated: 714 (51%) had no associated data, 664 (47%) had minimal-moderate data, and 30 (2%) had strong data. Maternal drug level category had the highest proportion of rigorous supportive data while the effect on lactation category had the least supportive data. Of the most common mediations used in lactating women, sex hormones (contraception) and the nervous system medication classes had the most robust supportive data while respiratory, blood forming organs, and galactogogues had the weakest supportive data.

CONCLUSION

There is significant variability and dearth in the quality of data guiding recommendations for use of medications in lactation providing numerous opportunities for research.

Association of illness perceptions and exclusive breastfeeding intentions among pregnant women with chronic conditions: A community-based pregnancy cohort study

OBJECTIVE

We examined whether changes in illness perceptions from preconception to pregnancy were associated with intentions to exclusively breastfeed to 6 months postpartum among women with chronic physical health conditions.

METHODS

We analyzed self-reported cross-sectional questionnaire data collected in the third trimester from 361 women with chronic conditions enrolled in a community-based cohort study (Alberta, Canada). For individual and total illness perceptions, measured with the Brief Illness Perception Questionnaire, women were classified using change scores (preconception minus pregnancy) into one of the following groups: "worsening," "improving," or "stable" in pregnancy. Intention to exclusively breastfeed was defined as plans to provide only breast milk for the recommended first 6 months after birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression modelling, with the "stable" group as the reference and controlling for demographic factors, chronic condition duration and medication, prenatal class attendance, and social support.

RESULTS

Overall, 61.8% of women planned to exclusively breastfeed to 6 months. Worsened total illness perceptions (adjusted OR 0.50, 95% CI 0.30-0.82) as well as perceptions of worsened identity (i.e., degree of symptoms; adjusted OR 0.49, 95% CI 0.28-0.85) or consequences (i.e., impact on functioning; adjusted OR 0.60, 95% CI 0.34-1.06) were associated with lower odds of intending to exclusively breastfeed to 6 months.

CONCLUSIONS

Women who perceive their illness experience to worsen during pregnancy are less likely to plan to exclusively breastfeed to 6 months in accordance with public health recommendations.

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.

Factors associated with exclusive formula feeding among individuals with low-risk pregnancies in the United States

BACKGROUND

Better understanding of the factors associated with formula feeding during the hospital stay can help in identifying potential lactation problems and promote early intervention. Our aim was to ascertain factors associated with exclusive formula feeding in newborns of low-risk pregnancies.

METHODS

A population-based, retrospective study using the United States vital statistics datasets (2014-2018) evaluating low-risk pregnancies with a nonanomalous singleton delivery from 37 to 41 weeks. People with hypertensive disorders, or diabetes, were excluded. Primary outcome was newborn feeding (breast vs exclusive formula feeding) during hospital stay. Adjusted relative risks (aRRs) with 95% confidence intervals (CI) were calculated.

RESULTS

Of the 19 623 195 live births during the study period, 11 605 242 (59.1%) met inclusion criteria and among them, 1 929 526 (16.6%) were formula fed. Factors associated with formula feeding included: age < 20 years (aRR 1.31 [95% CI 1.31-1.32]), non-Hispanic Black (1.42, 1.41-1.42), high school education (1.69, 1.69-1.70) or less than high school education (1.94, 1.93, 1.95), Medicaid insurance (1.52, 1.51, 1.52), body mass index (BMI) < 18.5 (1.10, 1.09-1.10), BMI 25-29.9 (1.09, 1.09-1.09), BMI 30-34.9 (1.19, 1.19-1.20), BMI 35-39.9 (1.31, 1.30-1.31), BMI ≥ 40 (1.43, 1.42-1.44), multiparity (1.29, 1.29-1.30), lack of prenatal care (1.49, 1.48-1.50), smoking (1.75, 1.74-1.75), and gestational age (ranged from 37 weeks [1.44, 1.43-1.45] to 40 weeks [1.11, 1.11-1.12]).

CONCLUSIONS

Using a large cohort of low-risk pregnancies, we identified several modifiable factors associated with newborn feeding (eg, prepregnancy BMI, access to prenatal care, and smoking cessation). Improving the breast feeding initiation rate should be a priority in our current practice to ensure equitable care for all neonates.

Study protocol for the sheMATTERS study (iMproving cArdiovascular healTh in new moThERS): a randomized behavioral trial assessing the effect of a self-efficacy enhancing breastfeeding intervention on postpartum blood pressure and breastfeeding continuation in women with hypertensive disorders of pregnancy

BACKGROUND

Individuals with hypertensive disorders of pregnancy (HDP) have an elevated lifetime risk of chronic hypertension, metabolic syndrome, and premature cardiovascular disease. Because breastfeeding duration and exclusivity have been associated in observational studies with improved cardiovascular health, optimizing breastfeeding in those with HDP might be an unrealized cardio-prevention approach, in particular because individuals with HDP have more breastfeeding challenges. Breastfeeding supportive interventions targeting one's breastfeeding self-efficacy have been shown to improve breastfeeding rates.

METHODS

We designed an open-label, multi-center 1:1 randomized behavioral trial to test whether a previously validated self-efficacy enhancing breastfeeding intervention can improve breastfeeding duration and/or exclusivity, and lower postpartum blood pressure at 12 months. Randomization is computer-generated and stratified by site (four hospitals in Montreal, Quebec and one hospital in Kingston, Ontario; all in Canada). Included are breastfeeding participants with HDP (chronic/gestational hypertension or preeclampsia) who delivered a live singleton infant at > 34 weeks, speak English or French, and have no contraindications to breastfeeding. Informed and written consent is obtained at hospitalization for delivery or a re-admission with hypertension within 1 week of discharge. Participants assigned to the intervention group receive a breastfeeding self-efficacy-based intervention delivered by a trained lactation consultant in hospital, with continued reactive/proactive support by phone or text message for up to 6 months postpartum. Regardless of group assignment, participants are followed for self-reported outcomes, automated office blood pressure, and home blood pressure at several time points with end of follow-up at 12 months.

DISCUSSION

This study will assess whether an intensive nurse-led behavioral intervention can improve breastfeeding rates and, in turn, postpartum blood pressure - an early marker for atherosclerotic cardiovascular disease. If effective, this form of enhanced breastfeeding support, along with closer BP and metabolic surveillance, can be implemented broadly in individuals lactating after HDP.

TRIAL REGISTRATION

ClinicalTrials.gov, # NCT04580927 , registered on Oct 9, 2020.

All-Cause Severe Maternal Morbidity (SMM) and Transfusion-Only SMM Are Independently Associated with a Lower Likelihood of Exclusive Breastfeeding

Background: The rates of severe maternal morbidity (SMM) including blood transfusions after delivery are rising, yet little is known about the impact of these experiences on breastfeeding. Materials and Methods: This is a single-institution retrospective cohort study examining breastfeeding rates at three time points for 1,857 first-time parents delivered at term between July 1, 2016 and June 30, 2019. Our exposure of interest was SMM, which was subdivided into SMM where transfusion was the only indicator (transfusion-only SMM) and SMM where another indicator (diagnostic or procedural) was met, which may also include transfusion (all-cause SMM). Association between transfusion-only SMM and all-cause SMM with feeding method was determined using multinomial regression modeling and adjusting for relevant sociodemographic characteristics. Results: The majority of those with uncomplicated deliveries were exclusively breastfeeding at the 2- to 4-week and 2- to 3-month time points (59.6% and 53.6%, respectively), in contrast to 46.3% and 42.0% of those who had experienced transfusion-only SMM, and 40.9% and 30% of those who had experienced all-cause SMM. In adjusted models, receipt of a blood transfusion was found to be associated with greater risk of exclusive formula feeding at all time points. Experience of all-cause SMM was significantly associated with increased likelihood of exclusive formula feeding at hospital discharge and the 2- to 3-month time point. Conclusions: We identified that experience of all-cause SMM and transfusion-only SMM are independently associated with a lower likelihood of exclusive breastfeeding after adjusting for sociodemographic factors. Perinatal clinicians should be aware of these risks and offer increased support to these couplets.

Does COVID-19 Policy Affect Initiation and Duration of Exclusive Breastfeeding? A Single-center Retrospective Study

Purpose

It assessed the effect of a COVID-19 policy that involved maternal-neonatal separation on early initiation and duration of exclusive breastfeeding (EBF) at two weeks, three, and six months postpartum during the peak of the COVID-19 pandemic in 2020.

Patients and Methods

This retrospective study included consecutive mother-newborn dyads with deliveries between mid-March and the end of December 2020 who agreed to participate and were eligible according to the following criteria: full-term pregnancy, singleton birth, and healthy newborn. Participants were called at least twice during the study period to inquire about exclusive breastfeeding status at two weeks, three, and six months postpartum. Multivariate logistic regression analysis was carried out to identify associated factors with EBF.

Results

A total of 454 eligible mother-infant dyads were included. Mean maternal age (in years), gestational age (in weeks), birth weight (in kilograms), and 5-min Apgar score was, respectively, 32±5.4 years, 39±1.3 weeks, 3.1±0.42 kg, and 9.24±0.6. Most of the mothers (86.1%) had no known chronic diseases and had a normal spontaneous vaginal delivery (NSVD, 91.4%). Approximately 44.7% of the sample initiated breastfeeding either directly or with expressed breastmilk during their hospital stay. Prevalence of EBF during the first two weeks, three, and six months postpartum was, respectively, 30%, 19.8%, and 31.7%. EBF was associated with birth weight, hospital breastfeeding and EIBF at early postpartum period, while EBF at six months was associated with parity and method of delivery.

Conclusion

During the peak of the COVID-19 pandemic, the prevalence of breastfeeding initiation and EBF in the first six months postpartum were low among Saudi mothers. However, multicenter, prospective, cohort studies with adjustment for known confounding factors are required to explore the impact of infection control policies on breastfeeding. Meanwhile, these policies should support early and safe breastfeeding practices, especially with new and evolving information regarding the current pandemic.

Breastfeeding practices in an Australian tertiary care hospital: A retrospective study

BACKGROUND

The World Health Organization recommend that infants be exclusively breastfed until six months of age. The Baby Friendly Health Initiative (BFHI) was developed for protecting, promoting, and supporting breastfeeding. The BFHI global criteria guides hospital practice for supporting infant feeding and reducing disparities in breastfeeding outcomes.

AIM

The aim of this study was to analyse 2019 data to identify factors that predict exclusive breastfeeding vs non-exclusive breastfeeding on discharge to determine areas for intervention in relation to BFHI guidelines.

MATERIAL AND METHODS

A retrospective chart review of 5836 neonates born at an Australian tertiary hospital in 2019 was conducted. Descriptive statistics were used to report exclusive breastfeeding rates. Univariate and logistic regression analyses were conducted to determine factors associated with exclusive breastfeeding and non-exclusive breastfeeding on discharge.

RESULTS

A total of 69% of neonates were exclusively breastfed on discharge in 2019. When excluding admissions to Newborn Services, 75% of neonates were exclusively breastfed on discharge, achieving the BFHI benchmark. Predictors which significantly reduced the odds of exclusive breastfeeding on discharge were maternal country of birth (Vietnam, p < 0.001, Sudan p < 0.001, Samoa p < 0.01, Philippines p < 0.05), main language (Other, p < 0.05), birth type (caesarean or assisted vaginal birth p < 0.001), first-feed type (mixed feeding or formula p < 0.001), and Newborn Services admission (p < 0.001).

CONCLUSIONS

Examining breastfeeding outcomes is an important quality assurance process for health services. Understanding groups of mothers who commence breastfeeding but do not exclusively breastfeed upon discharge enables identification of areas for intervention to achieve BFHI targets and reduce breastfeeding disparities.

Factors associated with early cessation of exclusive breast feeding among Saudi mothers: A prospective observational study

CONTEXT

World Health Organization recommending initiation of breastfeeding within hour of birth, exclusive breastfeeding for the first 6 months. In Saudi Arabia, there is a paucity of studies on the factors associated with early cessation of exclusive breastfeeding.

AIMS

We aimed to assess the exclusive breastfeeding rates and to identify the risk factors for early breastfeeding cessation at maternal and institutional levels.

SETTINGS AND DESIGN

A prospective observational study carried out at King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.

METHODS AND MATERIALS

It included all postpartum women who had given birth to full term, singleton, healthy newborns, and were breastfeeding before discharge. Data were collected before discharge, 2 weeks, and 8 weeks postpartum using an adapted instrument.

STATISTICAL ANALYSIS

Using JMP14 software with appropriate statistical tests.

RESULTS

The study included 136 mothers, of whom 37.5% were exclusively breastfeeding in the first 2 weeks; this rate dropped to 19% with a statistically significant difference (P < 0.0001). Early breastfeeding cessation was significantly associated with maternal age, health status, mother's knowledge, and attitude, in addition to other modifiable factors that was encountered during hospital stay such as latching difficulties and introduction of formula feeding.

CONCLUSIONS

This study reported low exclusive breastfeeding rates in the first 2 months postpartum among Saudi mothers. Multiple factors were associated with breastfeeding, and some are modifiable. Breastfeeding promotion and support for is a critical role required from healthcare workers in all settings, including primary health care. Healthcare professionals play a major role in promoting, protecting, and supporting exclusive breastfeeding.

Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort

Background

Prenatal medical risk describes physical health issues or biological factors that predate or arise during pregnancy which heighten the risk of adverse outcomes, and often warrant specialized obstetric care. The influence of the nature and magnitude of prenatal risk on breastfeeding outcomes remains poorly understood. The objective of this study was to determine the association between prenatal medical risk and breastfeeding initiation and duration up to 1 year postpartum.

Methods

We analysed a subset of data from the All Our Families longitudinal cohort (n = 2706) of women in Calgary, Canada who delivered a liveborn infant between 2008 and 2010. Data were collected from self-report questionnaires and medical records. Women with complete data on prenatal medical risk factors and breastfeeding outcomes were included in this analysis. Prenatal medical risk was operationalized as one integer score of risk severity and four binary risk types capturing pre-pregnancy characteristics, past obstetric problems, current obstetric problems, and substance use. Outcomes were breastfeeding initiation defined as the infant ever receiving breast milk, and duration operationalized as still breastfeeding at 4 months, at 12 months, and time to breastfeeding cessation in weeks. We used logistic regression and Cox regression with right censoring at 52 weeks or attrition to calculate odds ratios (OR) and hazard ratios (HR), respectively, adjusting for sociodemographic vulnerability, parity, mode of delivery, and gestational age.

Results

Prenatal medical risk severity and type were not significantly associated with breastfeeding initiation, with the exception of pre-pregnancy risk type (OR 0.45; 95% CI 0.26, 0.77). Risk severity was associated with lower odds of breastfeeding to 4 months (OR 0.94; 95% CI 0.90, 0.99), 12 months (OR 0.93; 95% CI 0.87, 0.98), and earlier breastfeeding cessation (HR 1.05; 95% CI 1.02, 1.08). Associations with shorter breastfeeding length across the first postpartum year were observed for pre-pregnancy, current obstetric, and substance use risk types, but not past obstetric problems.

Conclusion

Prenatal medical risk is associated with shortened duration of breastfeeding. Women with prenatal medical risk may benefit from the proactive arrangement of lactation support before and following delivery to promote continued breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00413-0.

Breastfeeding Practices and Problems Among Obese Women Compared with Nonobese Women in a Brazilian Hospital

Background: Women who are obese have lower rates of breastfeeding initiation and duration and are less likely to breastfeed exclusively compared with women who are not obese. To develop programs to improve breastfeeding practices among this group of women, we investigated the association between maternal obesity and breastfeeding practices and problems in the first days postpartum. Methods: We analyzed medical records from postpartum women at a rooming-in maternity ward in State of São Paulo, Brazil, between 2016 and 2018. We included those who had intended to exclusively breastfeed, had given birth to a singleton and were admitted to rooming-in. We analyzed exclusive breastfeeding and nonexclusive breastfeeding each day of hospitalization and the presence of breastfeeding problems, comparing women in the obese category (body mass index [BMI] ≥30 kg/m2) to normal and overweight women (≥18.6 to ≤29.9 kg/m2). Results: Two hundred and twenty-four postpartum women participated, including 86 women in the obese category. More than 50% of women with obesity reported a breastfeeding problem in the first and second postpartum days (p = 0.026 and p = 0.017, respectively) compared with the 41% and 38% nonobese group. Children of obese women were 2.8 times more likely to have poor latch during breastfeeding (95% confidence interval [CI]: 1.29-6.10) compared with the nonobese group on the third day. Conclusion: Maternal obesity increased the probability of breastfeeding difficulties and nonexclusive breastfeeding at discharge. Professionals need to support breastfeeding techniques in the days immediate after delivery to improve breastfeeding outcomes for mothers with obesity.

Barriers to Breastfeeding: Supporting Initiation and Continuation of Breastfeeding: ACOG Committee Opinion, Number 821

ABSTRACT

Breastfeeding has maternal, infant, and societal benefits. However, many parents experience obstacles to achieving their breastfeeding goals, leading to reduced rates of breastfeeding initiation and continuation. Despite efforts to increase rates of breastfeeding initiation and continuation, inequities still persist. The factors that influence an individual's desire and ability to breastfeed are varied and include individual parent considerations; practitioner influences; hospital barriers; societal factors, such as workplace and parental leave policies; access to lactation support; and social support of their breastfeeding goals. A multidisciplinary approach that involves community, family, parents, and health care professionals will strengthen the support for parents and help them achieve their breastfeeding goals.

Study of the phenolic compound profile and antioxidant activity of human milk from Spanish women at different stages of lactation: A comparison with infant formulas

Human milk (HM) has been proven to have important and essential antioxidant properties to counteract infant susceptibility to oxidative stress. Phenolic compounds are secondary metabolites which come from plants and are potent natural antioxidants. The ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method used in the present study allowed the quantification of 26 phenolic compounds (ten hydroxybenzoic acids, seven hydroxycinnamic acids, four flavonoids, three hydroxybenzaldehydes and two other polyphenols) in HM samples at different stages of lactation (colostrum, transitional milk and mature milk) and infant formulas (IF). Many of the phenolic compounds identified have been reported to be present in HM for the first time. The total phenolic compound content (TPC) was quantified using the Folin assay and the antioxidant activity (AC) was evaluated with the DPPH, ABTS and FRAP assays. Significant differences were evidenced between HM and IF. HM from mothers with an adherence to a Mediterranean diet contained twice as many individual phenolic compounds as infant formulas, with a higher proportion of hydroxybenzoic acids. Conversely, IF showed a higher proportion of hydroxycinnamic acids. Overall, the antioxidant activity of HM showed small variations during lactation.

Factors that influence mothers' prenatal decision to breastfeed in Spain

Background

Parents’ decisions about how to feed their newborns are influenced by multiple factors. Our objective was to identify the factors that can influence the decision to breastfeed.

Methods

Cross-sectional observational online study was conducted in Spain on women who gave birth between 2013 and 2018. The total number of participants was 5671. Data collection was after approval by the ethics committee in 2019. The data were collected retrospectively because the information was obtained from women who were mothers during the years 2013–2018. An online survey was distributed to breastfeeding associations and postpartum groups. Multivariate analysis with binary logistic regression was done to calculate the Adjusted Odds Ratios (aOR). The main result variable was “intention to breastfeed”.

Results

Ninety-seven percent (n = 5531) of women made the decision to breastfeed prior to giving birth. The internet played a role in deciding to breastfeed in 33.7% (n = 2047) of women, while 20.1% (n = 1110) said the same thing about their midwife. We identified five significant factors associated with the mother’s prenatal decision to breastfeed: attending maternal education (aOR 2.10; 95% CI 1.32, 3.34), having two (aOR 0.52; 95% CI 0.28, 0.99) and three children (aOR 0.24; 95% CI 0.10, 0.59), previous breastfeeding experience (aOR 6.99; 95% CI 3.46, 14.10), support from partner (aOR 1.58; 95% CI 1.09,2.28) and having a condition during pregnancy (aOR 0.62; 95% CI 0.43, 0.91).

Conclusions

Factors related with previous breastfeeding experience and education for mothers are decisive when it comes to making the decision to breastfeed. Given the proven influence that partners have in decision-making, it is important for them to be fully involved in the process.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-020-00341-5.

A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants

Aims The first aim was to describe the energy, carbohydrate and sugar contents of formula milk products in eleven countries. The second was to assess the labelling methods used. Based on the findings, approaches to facilitate the selection of infant-appropriate formula milk products were proposed.Background Consumption of excess sugar during infancy can increase the risk of non-communicable diseases (NCDs) including obesity, diabetes and dental caries. Reduction of sugar consumption has been high on the global public health agenda. Although most infants are fed formula milk products in addition to, or instead of, breastmilk (with only 38% exclusively breastfed), the sugar content of these products is often not included in sugar reduction strategies.Methods An exploratory study was conducted to describe the labelling and nutritional composition of a sample of infant formula products available in 11 countries. The sample, which was collected between May and August 2019, included commercially available formula products (n = 257) targeted at infants aged <3 years of age. The products were sold in supermarkets and by other major retailers across the sample countries. Primary data were obtained from labels on the packaging of the formula products.Results Findings suggest that the majority of products sampled were higher in total carbohydrate and carbohydrates of which sugar and lactose, than breastmilk, supporting previous research. The nutrition information presented on the products was often unclear and was inconsistent across the 11 counties sampled. None of the products had front-of-pack (FOP) nutritional information.Conclusion Findings suggest that globally, infant formula products are higher in carbohydrates, sugar and lactose than breastmilk. Labelling is unclear and inconsistent across brands and between countries. Based on the findings of this study, mandatory regulation of sugar content in formula products is needed with clear FOP nutrition information to help consumers choose the healthy option for their infants.

Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health

Human breast milk is considered the optimum feeding regime for newborn infants due to its ability to provide complete nutrition and many bioactive health factors. Breast feeding is associated with improved infant health and immune development, less incidences of gastrointestinal disease and lower mortality rates than formula fed infants. As well as providing fundamental nutrients to the growing infant, breast milk is a source of commensal bacteria which further enhance infant health by preventing pathogen adhesion and promoting gut colonisation of beneficial microbes. While breast milk was initially considered a sterile fluid and microbes isolated were considered contaminants, it is now widely accepted that breast milk is home to its own unique microbiome. The origins of bacteria in breast milk have been subject to much debate, however, the possibility of an entero-mammary pathway allowing for transfer of microbes from maternal gut to the mammary gland is one potential pathway. Human milk derived strains can be regarded as potential probiotics; therefore, many studies have focused on isolating strains from milk for subsequent use in infant health and nutrition markets. This review aims to discuss mammary gland development in preparation for lactation as well as explore the microbial composition and origins of the human milk microbiota with a focus on probiotic development.

Prenatal Provider Support for Breastfeeding: Changes in Attitudes, Practices and Recommendations Over 22 Years

BACKGROUND

Prenatal care providers play a central role in breastfeeding outcomes. A survey on obstetricians' support of breastfeeding was conducted in 1993 in Monroe County, NY. Since the landscape of prenatal care and breastfeeding support has changed significantly in the past 2 decades, we repeated and extended this survey in 2015.

RESEARCH AIM

To determine changes in breastfeeding support by prenatal care providers over a 20 year period.

METHODS

We sent a 46-item on-line or paper questionnaire to all categories of prenatal care providers identified by an online search. A breastfeeding support score was created based on the prior survey, with a maximum score of 3. One point was awarded for: (1) personally discussing breastfeeding; (2) generally suggesting breastfeeding; and (3) commonly receiving questions from patients. Data were analyzed using Chi-square.

RESULTS

We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p < .001) and recommending (93% vs. 80%, p = .001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p < .0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p < .001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p < .0001).

CONCLUSION

Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.

Formula Feeding and Associated Factors among a Group of Egyptian Mothers

BACKGROUND

Breastfeeding provides an unequalled way of infant nutrition, despite that, the rate of exclusive breastfeeding for the first 6 months in Egypt is only 13%, and the rates of artificial feeding are rising.

AIM

The current study aimed to explore the reasons for the use of artificial feeding among mothers receiving subsidised milk from formula dispensing centres in Egypt, and to detect the reasons behind the use of a formula only for infant feeding rather than mixed breastfeeding and artificial feeding.

METHODS

This exploratory cross-sectional study involved 197 mothers; who attended centres for dispensing subsidised artificial formula at primary health care facilities (PHC) in El-Fayom and Ismailia governorates via a purposive sampling technique. The study spanned over 6-months duration from June till December 2018.

RESULTS

A statistically significant higher percentage of artificial feeding only was noticed in male infants (47.5% in the AF group only versus 28.7% in the mixed feeding group (p = 0.018), and infants aged 6-12 months (47.5% in the AF group only versus 28.7% in the mixed feeding group, p = 0.032). A statistically significant higher percentage of artificial feeding only was noticed among infants born to mothers who have general anaesthesia during labour (67.2% in the AF group only versus 41.9% in the mixed feeding group, p = 0.004), and among infants born to mothers who think that formula feeding is better (13.1% in the AF group only versus 0.7% in the mixed feeding group, or that formula has a similar quality to breast milk (6.6%% in the AF group only versus 4.4% in the mixed feeding group, p = 0.0004. The most common reasons for formula feeding reported by both groups were perceived breast milk insufficiency (60.9%), weak babies (50.3%), and doctors' advice (37%). Previous negative breastfeeding experience and the need for own body privacy were the two reasons which differed statistically in both groups p = 0.004 and 0.008, respectively.

CONCLUSION

Antenatal care education is essential to improve mothers' knowledge and practice of breastfeeding. Baby-friendly hospital initiative implementation is essential to ensure early initiation and continuation of breastfeeding.

Timely initiation of breastfeeding among first time mothers in Bahir Dar city, North West, Ethiopia, 2016

BACKGROUND

Timely initiation of breastfeeding is one important intervention to prevent childhood morbidities and mortalities. Globally, not more than 35 and 39% in developing countries, 52% in Ethiopia and 38% in Amhara region were initiated with breastfeeding early.

METHODS

A community based cross-sectional study was conducted from 20 March to April, 2016. A total of 423 mothers who have infants less than 6 month old were included in this study. The data were collected using interviewer administered questionnaire. Binary logistic regression analysis were used to identify factors associated with timely initiation of breastfeeding.

RESULTS

Prevalence of timely initiation of breastfeeding was 65%. Being male [AOR 2.148 (1.232, 3.745)], breastfeeding counseling [AOR 2.163 (1.187, 3.942)], place of delivery [AOR 8.639 (2.089, 5.720)], normal labor [AOR 4.094 (1.414, 8.728], and religious father support [AOR 1.962 (1.113, 3.458)] were determinants for timely initiation of breastfeeding.

CONCLUSIONS

Timely initiation of breastfeeding in the study area was 65%. Sex of infant, breastfeeding counseling, birth place, mode of delivery, and religious father support were predictors of timely initiation of breastfeeding. Strengthening timely initiation of breastfeeding through provision of antenatal care services, educating mothers and strengthening health professionals knowledge, and skills on breastfeeding counseling were recommended.

Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review

Studies of gestational diabetes mellitus in relation to breastfeeding are limited, while their findings are inconsistent. This systematic review was conducted to assess the associations between gestational diabetes and breastfeeding outcomes. An initial search of PubMed, Web of Science, and ProQuest identified 518 studies, and after applying the inclusion criteria, 16 studies were finally included in the review. Four studies reported that “exclusive/predominant/full breastfeeding” rates at discharge were lower in mothers with gestational diabetes than in those without gestational diabetes, and 2 studies showed a shorter duration of “exclusive/predominant breastfeeding” in the former than in the latter. However, most studies found no apparent difference in the rate of “breastfeeding initiation”, “any breastfeeding” duration, or “any breastfeeding” in hospital and at discharge between mothers with and without gestational diabetes. In summary, mothers with gestational diabetes were less likely to exclusively breastfeed their infants and may have a shorter breastfeeding duration than other mothers.

Metabolic effects of breastfeed in women with prior gestational diabetes mellitus: A systematic review and meta-analysis

This study was undertaken to provide comprehensive analyses of current research developments in the field of breastfeed (BF) and metabolic-related outcomes among women with prior gestational diabetes mellitus (GDM). Database PubMed, Embase, BIOSIS Previews, Web of Science, and Cochrane Library were searched through December 3, 2017. Odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were pooled by random-effects model using Stata version 12.0. Twenty-three observational studies were included in quantitative synthesis. Reduced possibility of progression to type 2 diabetes mellitus (T2DM; OR = 0.79; 95% CI, 0.68-0.92) and pre-DM (OR = 0.66; 95% CI, 0.51-0.86) were found among women with longer BF of any intensity after GDM pregnancy. The positive effect of longer BF on progression to T2DM gradually became prominent with the extension of follow-up period. Compared with women with shorter BF, those with longer BF manifested more favourable metabolic parameters, including significant lower body mass index, fasting glucose, triglyceride, and higher insulin sensitivity index. The findings support that BF may play an important role in protection against the development of T2DM-related outcomes in midlife of women with prior GDM. However, further studies are needed to reveal the etiological mechanism.

In-hospital formula supplementation and breastfeeding initiation in infants born to women with pregestational diabetes mellitus

OBJECTIVE

To ascertain the rate of in-hospital supplementation as it relates to early breastfeeding (BF) and early formula feeding (FF) and its effects on BF (exclusive and partial) at the time of discharge for infants born to women with pregestational diabetes mellitus (PGDM).

METHODS

Retrospective cohort investigation of 282 women with PGDM who intended to BF and their asymptomatic infants admitted to the newborn nursery for blood glucose monitoring and routine care. Early feeding was defined by the initial feeding if given within four hours of birth.

RESULTS

Of the 282 mother-infant dyads, for 134 (48%) early feeding was BF and for 148 (52%) early feeding was FF. Times from birth to BF and FF (median 1 hr, 0.3-6) were similar, while the time to first BF for those who FF and supplemented was longer (median 6 hr., 1-24). Ninety-seven infants (72%) who first BF also supplemented. Of these, 22 (23%) BF exclusively, 67 (69%) BF partially and 8 (8%) FF at discharge. One hundred seventeen (79%) who first FF also supplemented. Of these, 21 (18%) BF exclusively, 76 (65%) BF partially and 20 (17%) FF at discharge.

CONCLUSION

Regardless of the type of first feeding, the majority of infants born to women with PGDM require supplementation. Even when medically indicated, in-hospital supplementation is an obstacle, albeit not absolute, to exclusive BF at discharge. Parents should be reminded that occasional supplementation should not deter resumption and continuation of BF.

Resources for Psychiatric Clinicians Working With Breastfeeding Mothers

In today's health care-focused climate, in which encouraging breastfeeding is part of national and international health care initiatives, clinicians in any field should have resources available for breastfeeding mothers. The current article provides information for psychiatric clinicians on how breastfeeding may affect women with psychiatric conditions, the type of lactation counselor likely to be best prepared to collaborate with psychiatric clinicians, and resources available regarding maternal psychiatric medications safe for breastfeeding infants. These resources can assist informed choices that support the mother's breastfeeding goals while providing the psychological care the nursing mother requires. [Journal of Psychosocial Nursing and Mental Health Services, 56(8),37-46.].

Infant Feeding Attitudes and Practices of Spanish Low-Risk Expectant Women Using the IIFAS (Iowa Infant Feeding Attitude Scale)

The Iowa Infant Feeding Attitude Scale (IIFAS) has been shown to have good psychometric properties for English-speaking populations, but it has not been validated among low-risk pregnant women in Spain. The aim of this study was to assess the reliability and validity of the translated version of the IIFAS in order to examine infant feeding attitudes in Spanish women with an uncomplicated pregnancy. Low-risk expectant women (n = 297) were recruited from eight primary public health care centres in Galicia (Spain). Questionnaires including both socio-demographic and breastfeeding characteristics and items about infant feeding were administered during the third trimester. Participants were contacted by telephone during the postpartum period to obtain information regarding their infant feeding status. Prediction validity and internal consistency were assessed. The translated IIFAS (69.76 ± 7.75), which had good psychometric properties (Cronbach's alpha = 0.785; area under the curve (AUC) of the receiver operating characteristic (ROC) curve = 0.841, CI95% = 0.735⁻0.948), showed more positive attitudes towards breastfeeding than towards formula feeding, especially among mothers who intended to exclusively breastfeed. This scale was also useful for inferring the intent to breastfeed and duration of breastfeeding. This study provides evidence that the IIFAS is a reliable and valid tool for assessing infant feeding attitudes in Spanish women with an uncomplicated pregnancy.

Decreasing NICU admissions of asymptomatic infants of women with pregestational diabetes mellitus improves breastfeeding initiation rates

BACKGROUND

Asymptomatic infants born to women with pregestational diabetes mellitus (PGDM) are usually admitted to the well baby nursery (WBN) while those who are symptomatic or in need of specialized care are admitted to the neonatal intensive care unit (NICU).

OBJECTIVE

To determine if changes in the NICU admission rate of asymptomatic infants born to women with PGDM during two different epochs affected breastfeeding (BF) initiation rates.

DESIGN/METHODS

Retrospective cohort investigation of 386 women with PGDM and their infants who delivered in 2008-11 (epoch 1) and 457 who delivered in 2013-16 (epoch 2) at a single institution.

RESULTS

NICU admissions: Comparison between epoch 1 and epoch 2 showed a decrease in the number of admissions from 243 (63%) to 175 (38%) *(chi square *p < 0.05). Respiratory distress (39 and 43%) and prematurity (28 and 23%) as admission diagnoses remained unchanged. Admissions for prevention of hypoglycemia declined (32% to 21%)*. At discharge from the NICU, exclusive BF (12 to 19%)* and any BF increased (41 to 55%)* while formula feeding (FF) decreased (59 to 45%)*. Admission to the NICU remained a strong predictor of BF initiation failure (a OR 0.6, 95% , CI 0.4-0.9, p 0.005).WBN admissions: Comparison between epoch 1 and epoch 2 showed an increase in the number of admissions from 143 (37%) to 282 (62%)*. The incidence of hypoglycemia (31% and 38%) and its correction with oral feedings (76% and 71%) remained unchanged. At discharge from the WBN, exclusive BF (15 to 27%)* and any BF (52 to 62%)* increased while FF decreased (48 to 38%)*.

CONCLUSIONS

A decrease in the number of NICU admissions of asymptomatic infants born to women with PGDM is associated with improvements in BF initiation rates.

Early feeding, hypoglycemia and breastfeeding initiation in infants born to women with pregestational diabetes mellitus

OBJECTIVE

To examine the effects of early breastfeeding (eBF) or early formula feeding (eFF) on hypoglycemia and on BF initiation in infants born to women with pregestational diabetes mellitus (PGDM) who intended to BF.

METHODS

Retrospective cohort investigation of 554 women with PGDM and their infants (IDMs) who delivered during 2008-2016. The first feeding (BF or FF) was considered early if given within 4 hours from birth.

RESULTS

282 (51%) IDMs were admitted to the Well Baby Nursery. Of the 134 IDMs whose early feeding was BF, hypoglycemia affected 30% which was corrected with oral feedings in 78% of the cases. At discharge, 49% BF exclusively while 45% BF partially. Of the 148 IDMs whose early feeding was FF, hypoglycemia affected 40% which was corrected with oral feedings in 69% of the cases. At discharge, 14% BF exclusively while 48% BF partially. There were 272 (49%) IDMs admitted to the NICU. Their early feeding was BF (14%) and FF (86%). Hypoglycemia developed in 50% and 43% of these groups, respectively. Benefits of early feedings on hypoglycemia were masked by the routine use of IV dextrose infusions. At discharge, early BF led to exclusive BF in 45% and partial BF in 50% of the cases. Early FF led to exclusive BF in 17% and partial BF in 42% of the cases.

CONCLUSIONS

Early and continued feeding (BF preferably or FF if BF is not feasible) should be the first line of treatment for hypoglycemia. Early BF is paramount for BF initiation. Early FF is an obstacle, albeit not absolute, to BF initiation, thus it should not deter continued efforts to start or resume BF.

Support for mothers and their families after life-threatening illness in pregnancy and childbirth: a qualitative study in primary care

BACKGROUND

One in 100 women who give birth in the UK develop life-threatening illnesses during childbirth. Without urgent medical attention these illnesses could lead to the mother's death. Little is known about how the experience of severe illness in childbirth affects the mother, baby, and family.

AIM

As part of the UK National Maternal Near-miss Surveillance Programme, this study explored the experiences of women and their partners of life-threatening illnesses in childbirth, to identify the long-term impact on women and their families.

DESIGN AND SETTING

Qualitative study based on semi-structured narrative interviews. Interviews were conducted in patients' homes in England and Scotland from 2010 to 2014.

METHOD

An in-depth interview study was conducted with 36 women and 11 partners. A maximum variation sample was sought and interviews transcribed for thematic analysis with constant comparison.

RESULTS

Women's birth-related illnesses often had long-lasting effects on their mental as well as physical health, including anxiety, panic attacks, and post-traumatic stress disorder. In some cases the partner's mental health was also affected. Women often described feeling isolated. Their experiences can have a profound impact on their relationships, family life, career, and future fertility. While some women described receiving good support from their GP, others felt there was little support available for them or their families after discharge from hospital.

CONCLUSION

A near-miss event can have long-lasting and major effects on women and their families. Support in primary care, including watchful waiting for mental health impacts, can play a valuable role in helping these families come to terms with their emergency experience. The findings highlight the importance of communication between primary and secondary care.

Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review

Rates of breastfeeding uptake are lower after a caesarean birth than vaginal birth, despite caesarean rates increasing globally over the past 30 years, and many high-income countries reporting overall caesarean rates of above 25%. A number of factors are likely to be associated with women's infant feeding decisions following a caesarean birth such as limited postoperative mobility, postoperative pain, and ongoing management of medical complications that may have triggered the need for a caesarean birth. The aim of this systematic review was to evaluate evidence of interventions on the initiation and duration of any and exclusive breastfeeding among women who had a planned or unplanned caesarean birth. Seven studies, presenting quantitative and qualitative evidence, published in the English language from January 1994 to February 2016 were included. A limited number of interventions were identified relevant to women who had had a caesarean birth. These included immediate or early skin-to-skin contact, parent education, the provision of sidecar bassinets when rooming-in, and use of breast pumps. Only one study, an intervention that included parent education and targeted breastfeeding support, increased initiation and continuation of breastfeeding, but due to methodological limitations, findings should be considered with caution. There is a need to better understand the impact of caesarean birth on maternal physiological, psychological, and physical recovery, the physiology of lactation and breastfeeding and infant feeding behaviors if effective interventions are to be implemented.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Background

Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.

Objectives

To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.

Methods

Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.

Setting

Maternity units in all four countries of the UK.

Participants

Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity.

Main outcome measures

The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.

Results

Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.

Limitations

This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.

Conclusions

Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Review of Infant Feeding: Key Features of Breast Milk and Infant Formula

Mothers' own milk is the best source of nutrition for nearly all infants. Beyond somatic growth, breast milk as a biologic fluid has a variety of other benefits, including modulation of postnatal intestinal function, immune ontogeny, and brain development. Although breastfeeding is highly recommended, breastfeeding may not always be possible, suitable or solely adequate. Infant formula is an industrially produced substitute for infant consumption. Infant formula attempts to mimic the nutritional composition of breast milk as closely as possible, and is based on cow's milk or soymilk. A number of alternatives to cow's milk-based formula also exist. In this article, we review the nutritional information of breast milk and infant formulas for better understanding of the importance of breastfeeding and the uses of infant formula from birth to 12 months of age when a substitute form of nutrition is required.

Midwifery care and patient-provider communication in maternity decisions in the United States

To characterize reasons women chose midwives as prenatal care providers and to measure the relationship between midwifery care and patient-provider communication in the U.S.

CONTEXT

Retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 to a single newborn in a U.S. hospital (n = 2,400). We used multivariate logistic regression models to characterize women who received prenatal care from a midwife, to describe the reasons for this choice, and to examine the association between midwife-led prenatal care and women's reports about communication. Preference for a female clinician and having a particular clinician assigned was associated with higher odds of midwifery care (AOR = 2.65, 95 % CI 1.70, 4.14 and AOR = 1.63, 95 % CI 1.04, 2.58). A woman with midwifery care had lower odds of reporting that she held back questions because her preference for care was different from her provider's recommendation (AOR = 0.46, 95 % CI 0.23, 0.89) or because she did not want to be perceived as difficult (AOR = 0.48, 95 % CI 0.28, 0.81). Women receiving midwifery care also had lower odds of reporting that the provider used medical words were hard for them to understand (AOR = 0.58, 95 % CI 0.37, 0.91) and not feeling encouraged to discuss all their concerns (AOR = 0.54, 95 % CI 0.34, 0.89). Women whose prenatal care was provided by midwives report better communication compared with those cared for by other types of clinicians. Systems-level interventions, such as assigning a clinician, may improve access to midwifery care and the associated improvements in patient-provider communication in maternity care.

Why invest, and what it will take to improve breastfeeding practices?

Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.

Failure to initiate breastfeeding among high risk obstetrical patients who intended to breastfeed

BACKGROUND

In the US, at the time of discharge from the hospital, 79% of women had initiated breastfeeding. Intention to breastfeed is a strong predictor of breastfeeding initiation; however, we reported initiation failure in 45% of women with pregestational diabetes who intended to breastfeed. Information regarding intention and initiation among women with other high risk obstetrical conditions (HROB) remains scarce.

OBJECTIVE

To ascertain demographic and clinical factors associated with breastfeeding initiation failure among women with HROB conditions who intended to breastfeed.

METHODS

The study population is comprised of 89 women with diabetes (DM), 57 who were receiving treatment for substance abuse (SA), 51 women diagnosed with miscellaneous (MISC) conditions and 32 with history of preterm labor/delivery (PTL/D). Intention to exclusively breastfeed or in combination with formula (breastfed/FF) was ascertained prenatally. Breastfeeding was considered initiated if at discharge ≥50% of their infant feedings were maternal milk. Statistics include chi-square, Wilcoxon's and logistic regression (p < 0.05).

RESULTS

Of all women, 59% initiated any breastfeeding. Intention to breastfeed/FF, lack of mother-infant contact during the first hour following birth and limited lactation consultation were predictive of initiation failure. The odds of initiation failure were 2.3 times higher among women who wished to breastfeed/FF as compared to those who wished to exclusively breastfeed. Women from the SA group had lower rates of initiation failure than the other three HROB groups.

CONCLUSION

Intention to breastfeed among women with diverse HROB conditions is similar to that of the general population; however, initiation rates are disappointingly low. Intention to exclusively breastfeed results in fewer initiation failures. Prenatal intention to combine breast and formula feeding characterize women who may benefit from specific educational programs.