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Nardella D, Canavan M, Sharifi M, Taylor S. Quantifying the Association between Pump Use and Breastfeeding Duration. J Pediatr 2024; 274:114192. [PMID: 39004167 DOI: 10.1016/j.jpeds.2024.114192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/03/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To quantify the extent to which pump use is associated with breastfeeding duration. STUDY DESIGN We conducted a cross-sectional analysis of weighted data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System from Maine, Michigan, New Mexico, and Utah between 2016 and 2021. Included respondents had a live-born infant at survey completion, initiated breastfeeding, and had nonmissing data for reported pump use and breastfeeding duration. Using Cox proportional hazard regression, we quantified the hazard of breastfeeding cessation and median duration (weeks) of breastfeeding by pump use. Pump use was suspected to be differentially impacted by race and ethnicity; an interaction was tested in our regression model. RESULTS Our sample included 19 719 mothers (weighted n = 723 808) with mean age (SD) 29.5 years (5.6). Mothers with age <18 years, Medicaid enrollment, race, and ethnicity other than non-Hispanic White, lower income or education, and unmarried status demonstrated lower pump use (P < .001). Pump use was associated with 37% lower hazard of breastfeeding cessation (adjusted hazard ratio 0.63; 95% CI: 0.56-0.70) and 21 additional weeks of breastfeeding on average. The association varied by race and ethnicity (significant interaction observed between pump use and non-Hispanic Black mothers, P = .013); stratified analysis demonstrated the lowest hazard of breastfeeding cessation among non-Hispanic Black and Native American pump users (adjusted hazard ratio 0.47 [0.40-0.54] and 0.51 [0.37-0.70], respectively). CONCLUSIONS Pump use was associated with longer breastfeeding duration; the greatest magnitudes of association were found among non-Hispanic Black and Native American participants, groups disproportionately affected by breastfeeding inequities. Future research examining the context around and causal impact of pump use on breastfeeding outcomes is needed.
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Affiliation(s)
- Deanna Nardella
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Pediatrics, Yale School of Medicine, New Haven, CT.
| | - Maureen Canavan
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), New Haven, CT
| | - Mona Sharifi
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Sarah Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
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2
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Nardella D. Pumps: A Possible Tool to Promote More Equitable Lactation Outcomes. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:99-106. [PMID: 38559458 PMCID: PMC10964822 DOI: 10.59249/mwyw7163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Pregnant individuals and infants in the US are experiencing rising morbidity and mortality rates. Breastfeeding is a cost-effective intervention associated with a lower risk of health conditions driving dyadic morbidity and mortality, including cardiometabolic disease and sudden infant death. Pregnant individuals and infants from racial/ethnic subgroups facing the highest risk of mortality also have the lowest breastfeeding rates, likely reflective of generational socioeconomic marginalization and its impact on health outcomes. Promoting breastfeeding among groups with the lowest rates could improve the health of dyads with the greatest health risk and facilitate more equitable, person-centered lactation outcomes. Multiple barriers to lactation initiation and duration exist for families who have been socioeconomically marginalized by health and public systems. These include the lack of paid parental leave, increased access to subsidized human milk substitutes, and reduced access to professional and lay breastfeeding expertise. Breast pumps have the potential to mitigate these barriers, making breastfeeding more accessible to all interested dyads. In 2012, The Patient Protection and Affordable Care Act (ACA) greatly expanded access to pumps through the preventative services mandate, with a single pump now available to most US families. Despite their near ubiquitous use among lactating individuals, little research has been conducted on how and when to use pumps appropriately to optimize breastfeeding outcomes. There is a timely and critical need for policy, scholarship, and education around pump use given their widespread provision and potential to promote equity for those families facing the greatest barriers to achieving their personal breastfeeding goals.
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Affiliation(s)
- Deanna Nardella
- National Clinician Scholars Program, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New
Haven, CT, USA
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Fan HSL, Fong DYT, Lok KYW, Tarrant M. Experiences of expressed human milk feeding: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 38:100903. [PMID: 37657300 DOI: 10.1016/j.srhc.2023.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/28/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The objective of this study was to understand and describe the breastfeeding experiences of Chinese women with a high proportion of expressed human milk feeding. METHODS A qualitative descriptive design was used to describe the usual practices of expressed human milk feeding among breastfeeding women. We conducted semi-structured, in-depth, one-to-one interviews with participants (N = 25) who had a high proportion of expressed human milk feeding. Thematic analysis was used to analyze the data. RESULTS We identified three main themes: a sense of control, a sense of security, and milk expression challenges. Participants described that expressed human milk feeding provided a greater sense of control over their time and provided more freedom as they were no longer restricted by their infant's feeding schedule. Furthermore, knowing the amount of milk and having a stored milk supply provided a sense of security. However, providing expressed human milk can be time-consuming and has a lower intimacy level when compared with direct breastfeeding. CONCLUSION Expressed human milk feeding can provide a greater sense of control and was used as an immediate solution to direct breastfeeding problems. However, some participants experienced challenges in expressed human milk feeding, and some preferred breastfeed directly. Therefore, it is crucial to strengthen the breastfeeding support provided in the early postpartum period to ensure that all breastfeeding persons can breastfeed directly.
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Affiliation(s)
- Heidi Sze Lok Fan
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada.
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Marie Tarrant
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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Hubbard L, Reis P, Neil J. Beliefs and Decision-Making of First-Time Mothers Planning to Use a Breast Pump. J Perinat Educ 2023; 32:202-212. [PMID: 37974663 PMCID: PMC10637317 DOI: 10.1891/jpe-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2023] Open
Abstract
Beliefs and decision-making processes associated with breast pump use in first-time mothers providing human milk to healthy, term newborns soon after birth are explored in this qualitative, descriptive study. Eight women participated in an individual semistructured interview in a community hospital in the southeastern United States. Guided by the theory of planned behavior, conventional content analysis about prenatal and early postpartum beliefs of planning and utilizing breast pumps yielded themes of Resource Gathering, Intention Refining, and Behavior Navigating. An understanding of these beliefs gives insight into ways health professionals can increase collaboration with expectant and new mothers about the selection and safe use of breast pumps, resource availability at various stages, and infant-feeding goals.
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Affiliation(s)
- Lori Hubbard
- Correspondence regarding this article should be directed to Lori Hubbard, PhD, RN, IBCLC. E-mail:
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Gutierrez Dos Santos B, Shenker N, Weaver G, Perrin MT. Comparison of Breastfeeding and Pumping Experiences of Milk Bank Donors in the United States and United Kingdom. Breastfeed Med 2023; 18:870-880. [PMID: 37889994 DOI: 10.1089/bfm.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Background/Objective: As human milk banking services expand, information about lifestyle characteristics and infant feeding experiences of milk bank donors is relatively limited. Our goal was to describe and compare milk bank donors' demographic, clinical, and lifestyle characteristics, and breastfeeding experiences in a variety of geographic settings. Methods: A cross-sectional online survey was conducted from August 2022 to December 2022 with approved donors from three milk banks in the United States (n = 369), and one milk bank in United Kingdom (n = 187). Results: Donors in all settings were predominantly in their early 30s, White, married, educated, and identified as female. U.K. donors reported more frequently being on maternity leave (33% versus 5%, p < 0.001), predominantly feeding directly at the breast in the first 3 months postpartum (51% versus 28%, p < 0.001), and breastfeeding a single child longer (21.2 versus 13.3 months, p < 0.001) than U.S. donors. Significantly more U.S. donors reported pumping due to work (34% versus 11%, p < 0.001) and pumping multiple times per day (57% versus 36%, p < 0.001). Most donors reported receiving information about breastfeeding from a health care provider (94% United States and 88% United Kingdom, p = 0.022), while the internet was the most popular source of information about pumping (65% United States and 64% United Kingdom, p = 0.751). Conclusion: Factors not directly related to milk banking (e.g., maternity leave, sources of breastfeeding/pumping assistance) may have an impact on how donors feed their children and ultimately on their milk donation pattern. The impact of donor characteristics and feeding practices on donation patterns warrants further investigation.
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Affiliation(s)
| | - Natalie Shenker
- Human Milk Foundation, Rothamsted Institute, Harpenden, United Kingdom
- Department of Surgery and Cancer, Imperial College London, IRDB, London, United Kingdom
| | - Gillian Weaver
- Human Milk Foundation, Rothamsted Institute, Harpenden, United Kingdom
| | - Maryann T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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Magalhães M, Havelaar AH, Varma DS, Cacho N, Sullivan S, Parker LA. Leveraging mHealth and a milk expression frequency biomarker during postpartum to prolong lactation among parents of critically ill infants: a pilot study. J Perinatol 2023; 43:616-623. [PMID: 36882532 PMCID: PMC9991875 DOI: 10.1038/s41372-023-01639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To assess the feasibility and potential benefits of personalized biomarker-based text messages in prolonging lactation among parents of critically ill infants. STUDY DESIGN Thirty-six participants were randomized to receive either daily texts with Mother's Own Milk (MOM) sodium levels or standard care. Surveys at months 1 and 3 assessed whether infants were receiving exclusive MOM feeding, any MOM feeding, and whether the parent was still lactating. Kaplan-Meier and log-rank tests were used for time-to-event analysis within and between intervention and control groups. RESULTS Participants were predominantly on Medicaid (72%), delivered infants <1500 g, and by c-section (56%). Kaplan-Meier probabilities at month 3 suggest prolonged MOM feeding (63% [0.95CI, 0.43-0.91] vs. 41% [0.95CI, 0.21-0.67]) and lactation (63% [0.95CI, 0.42-0.95] vs. 37% [0.95CI, 0.18-0.76]) in the enhanced group compared to the control group. CONCLUSION Personalized biomarker-based text messages are feasible and may prolong lactation and MOM feeding among parents of critically ill infants.
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Affiliation(s)
- Marina Magalhães
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA. .,Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Arie H Havelaar
- Department of Animal Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.,Food Systems Institute, University of Florida, Gainesville, FL, USA
| | - Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole Cacho
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra Sullivan
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Leslie A Parker
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Quinn EA, Sobonya S, Palmquist AE. Maternal perceptions of human milk expression output: An experimental design using photographs of milk. Soc Sci Med 2023; 324:115871. [PMID: 37023658 DOI: 10.1016/j.socscimed.2023.115871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/20/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The widespread use of breast pumps in the United States is a recent phenomenon that is reshaping how individuals understand and perceive lactation. In the 1990s, adequacy of milk supply was primarily measured indirectly by infant weight gain and/or diapers; now >95% of all lactating persons in the United States use breast pumps and are seeing their milk regularly. How seeing milk impacts the perception of lactation sufficiency is an important area of research. Research aim/question: To understand personal and intersubjective influences of seeing expressed human milk on perceptions of milk supply among participants who express milk for their infants. METHODS We surveyed 805 lactating participants from the United States about their pumping practices using an online survey. Participants described pumping practices, milk output, and beliefs. They were then randomized to view one of three photographs of expressed milk (<2 oz, 4 oz, >6oz) and asked to imagine they had just pumped that amount and provide a written response; this created 4 exposure groups (2 increase and 2 decrease) and a control group (no difference). RESULTS Participants randomized to a higher volume reported more positive feelings and used the terms "good", "great", and "accomplished" to describe emotional responses to output. Participants randomized to lower milk volumes reported more feelings of "bad" or "depressed." A subset of participants reported feeling "annoyed" about small volumes of milk. CONCLUSIONS Participants in this study were very conscious of the volume of milk pumped each session; both increases and decreases were associated with emotional responses that could contribute to decisions about pumping practices, perceived milk supply, and lactation duration.
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8
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Fan HSL, Fong DYT, Lok KYW, Tarrant M. A Qualitative Exploration of the Reasons for Expressed Human Milk Feeding Informed by the Breastfeeding Self-Efficacy Theory. J Hum Lact 2023; 39:146-156. [PMID: 35414281 DOI: 10.1177/08903344221084629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is an increasing prevalence of expressed human milk feeding. The reasons for expressed human milk feeding of healthy term infants may differ from those for preterm infants. The process of adopting expressed human milk feeding for healthy full-term infants has not been well-described in the existing literature. RESEARCH AIM To describe the reasons for, and antecedents to, expressed human milk feeding among Chinese women who used a high proportion of expressed human milk for feeding. METHODS A descriptive, prospective cross-sectional qualitative design was used. Participants (N = 25) who used a high proportion of expressed human milk feeding were recruited from a larger perspective cohort study in two public hospitals in Hong Kong. Semi-structured, in-depth, one-to-one interviews were conducted 2017-2018. Data collection and thematic analysis were guided by the Breastfeeding Self-Efficacy Theory. RESULTS The authors conducted thematic analysis and identified six core themes: (1) perceived maternal roles; (2) breastfeeding role models; (3) negative feedback from social networks; (4) negative direct breastfeeding experiences; (5) expressed human milk feeding as a solution to a problem; and (6) advice from health care professionals to express human milk. These themes were consistent with the four antecedents of the Breastfeeding Self-Efficacy Theory (e.g., physiological and affective state, vicarious experiences, performance accomplishments, and verbal persuasion). CONCLUSIONS The main reason for participants to feed expressed human milk was experiencing difficulties with direct breastfeeding. Expressed human milk feeding was used as an immediate solution for breastfeeding problems. Strengthening breastfeeding support in the early postpartum period may decrease the perceived need for human milk expression.
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Affiliation(s)
- Heidi Sze Lok Fan
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Marie Tarrant
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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9
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Pommeret-de Villepin B, Barasinski C, Rigourd V. Initiating and Supporting Breastfeeding: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S56-S73. [PMID: 36480673 DOI: 10.1111/jmwh.13420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Exclusive breastfeeding is recommended for children for the first 4 to 6 months of life, with complementary foods added thereafter. It is the most ecological way of protecting the child's and mother's health. Training of health professionals is required to avoid transmitting inconsistent information in 3 areas: 1) implementing these 3 predictors: safe skin-to-skin, first breastfeed, and rooming-in 24/7; 2) teaching and monitoring: i) early signs of waking and feeding rhythms, ii) positioning and latching, and iii) signs of effective transfer; and 3) referring women to specialized support services if difficulties arise (eg, inadequate milk production, pain, cracked nipples, engorgement). Breastfeeding should continue during mastitis or an abscess. Ultrasound-guided needle aspiration is beneficial in treating an abscess. Précis: Information is provided to enable health professionals to better support breastfeeding and help women with the most common difficulties, thus promoting breastfeeding initiation and duration.
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Affiliation(s)
- Brune Pommeret-de Villepin
- Service gynécologie-obstétrique, Centre hospitalier de Tourcoing, 155 rue du Président-René-Coty, Tourcoing, 59200, France
| | - Chloé Barasinski
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Axe TGI-DecisipH, Clermont-Ferrand, F-63000, France
| | - Virginie Rigourd
- Pédiatre en néonatalogie médecin responsable du lactarium régional d'Ile de France Hopital, Necker Enfants malades, Paris, France
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Di Ruggiero E, Dennis CL, Kiss A, O'Connor DL, Sellen DW. Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada. BMJ Open 2022; 12:e055830. [PMID: 35676013 PMCID: PMC9185489 DOI: 10.1136/bmjopen-2021-055830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months. DESIGN Pooled data from two prospective cohort studies SETTING: Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada. PARTICIPANTS 337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum. EXCLUSIONS pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Main exposure variable: any use of expressed human milk at 2 weeks postpartum. OUTCOMES cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum. RESULTS All participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84). TRIAL REGISTRATION NUMBERS NCT03400605, NCT03589963.
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Affiliation(s)
- Alison Mildon
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Francis
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Yi Man Ng
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Pediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Daniel W Sellen
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Anthropology, Faculty of Arts and Sciences, University of Toronto, Toronto, Ontario, Canada
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Lundquist A, McBride BA, Donovan SM, Wszalek M. Father support for breastfeeding mothers who plan to utilize childcare: A qualitative look at Mothers' perspectives. Appetite 2022; 169:105854. [PMID: 34890723 DOI: 10.1016/j.appet.2021.105854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 02/02/2023]
Abstract
Breastfeeding exerts many health benefits for the infant and the benefit is affected by exclusivity and duration, however, most mothers in the U.S. breastfeed for a shorter duration than recommended. First-time mothers who return to work outside the home, utilize childcare, and pump to continue to provide human milk, all of which have been found to reduce breastfeeding duration individually, represent a subset of breastfeeding mothers facing several known barriers to breastfeeding continuation and at risk for early breastfeeding cessation. The aim of this study is to understand and describe the perceptions of first-time mothers with prenatal intentions to breastfeed and utilize childcare, of paternal support for the breastfeeding experience. A semi-structured interview guided data collection with 24 first-time breastfeeding mothers and responses were analyzed using thematic analysis. Two main themes from mothers' experiences highlight the perceptions of first-time mothers, who had prenatal intentions to breastfeed and utilize childcare, were shaped by the actions, behaviors, and beliefs of their partners throughout the breastfeeding process, as well as illustrate both mothers and fathers lack knowledge of how to optimally involve fathers in breastfeeding. Our findings extend evidence for two existing models of father support to promote breastfeeding as relevant to mothers who return to work outside the home and utilize childcare, and additionally identify an area of support not included in either model. Early and improved education that situates breastfeeding within the co-parenting relationship and includes paternal support for pumping has the potential to improve mothers' breastfeeding experience and breastfeeding duration through mothers' return to work and infants' transition to childcare.
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Affiliation(s)
- Alexandra Lundquist
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Child Development Lab, 1105 West Nevada Street, Urbana, IL, 61801, USA.
| | - Brent A McBride
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Child Development Lab, 1105 West Nevada Street, Urbana, IL, 61801, USA; Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, 2013 Christopher Hall, 904 West Nevada Street, Urbana, IL, 61801, USA.
| | - Sharon M Donovan
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 339 Bevier Hall, 905 S. Goodwin Ave, Urbana, IL, 61801, USA.
| | - Maris Wszalek
- Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
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Riley J, Cherkerzian S, Benjamin C, Belfort MB, Sen S, Drouin K, Gregory K. Clinical Characteristics and Breastfeeding Outcomes in Term Dyads Following In-Hospital Supplementation with Pasteurized Donor Human Milk or Formula. Breastfeed Med 2021; 16:717-724. [PMID: 33872065 DOI: 10.1089/bfm.2020.0337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Pasteurized donor human milk (PDHM) supplementation for healthy infants is an emerging practice. Little is known about demographics or breastfeeding outcomes for dyads whose mothers choose PDHM versus formula. Research Aims: To identify relationships between in-hospital supplementation choice and (1) dyad characteristics and breastfeeding intent, and (2) breastfeeding outcomes at 1 month. Materials and Methods: This exploratory prospective cohort study surveyed healthy dyads requiring medically indicated supplementation. Participants completed questionnaires including demographics, breastfeeding intent, and self-efficacy during hospitalization, and self-efficacy and lactation outcomes at 1 month. Results: Of 39 participants, 24 (62%) supplemented with formula and 15 (38%) with PDHM. Formula dyads were more likely than PDHM dyads to have a delivery body mass index (BMI) ≥30 kg/m2 (58% versus 20%, p = 0.02), and less likely to have attained greater than a college degree (33% versus 7%, p = 0.02); formula dyads also reported lower breastfeeding intent scores (12.0 versus 15.5, p = 0.002). Breastfeeding self-efficacy scores were similar but decreased for both groups over 1 month. At 1 month, mothers who chose formula were more likely to continue to provide breast milk to their infants (84% versus 72%). Direct breastfeeding rates were similar (72% versus 68%); of participants directly breastfeeding at 1 month, PDHM dyads were 1.5 times more likely to provide maternal expressed milk. Conclusions: Differences in maternal education, BMI, and breastfeeding intent were found between feeding groups. Results suggest an association between PDHM choice and initial breastfeeding intent and breastfeeding self-efficacy and provision of maternal expressed milk at 1 month.
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Affiliation(s)
- Jennifer Riley
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charis Benjamin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
| | - Kaitlin Drouin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katherine Gregory
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
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Von Kohorn I, Flaherman V. Human Milk for the Term Newborn. Clin Perinatol 2021; 48:513-531. [PMID: 34353578 DOI: 10.1016/j.clp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.
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Affiliation(s)
- Isabelle Von Kohorn
- Department of Pediatrics, Holy Cross Health, 1500 Forest Glen Road, Silver Spring, MD 20910, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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14
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Fan HSL, Fong DYT, Lok KYW, Tarrant M. Association between expressed breast milk feeding and breastfeeding duration in Hong Kong mothers. Women Birth 2021; 35:e286-e293. [PMID: 34238703 DOI: 10.1016/j.wombi.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Expressed breast milk feeding has increased substantially in the past two decades. Once used primarily for preterm infants, feeding expressed breast milk is now more common in mothers giving birth to healthy term infants. However, the effect of expressed breast milk feeding on breastfeeding duration is unclear. OBJECTIVES To assess the association between breast milk expression practices and breastfeeding duration in women giving birth to healthy infants. METHODS From 2017 to 2018, we recruited 821 new mothers from two public hospitals in Hong Kong. Participants were followed up at 1.5, 3, and 6 months postpartum or until they stopped breastfeeding. The proportion, type, and mode of all milk feeding were assessed at each follow-up. RESULTS At 1.5 months postpartum, 47.9%, 37.7%, and 14.4% of participants were feeding by direct breastfeeding only, mixed-mode feeding, and expressed breast milk only, respectively. Participants feeding expressed breast milk only were more likely to be supplementing with infant formula. When compared with participants who provided only direct breastfeeding, participants who gave only expressed breast milk at 1.5 months had 57% lower odds of breastfeeding continuation at three months postpartum. After stratification by infant formula supplementation, expressed breast milk feeding only at 1.5 months was associated with an increased risk of breastfeeding cessation in participants supplementing with infant formula (adjusted hazard ratio [aHR] = 1.86, 95% CI = 1.17-2.95). CONCLUSION In the first six months postpartum, giving only expressed breast milk is associated with early breastfeeding cessation, especially in participants who are also supplementing with infant formula.
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Affiliation(s)
- Heidi Sze Lok Fan
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
| | - Marie Tarrant
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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15
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Cordero L, Stenger MR, Landon MB, Nankervis CA. Breastfeeding initiation among women with preeclampsia with and without severe features. J Neonatal Perinatal Med 2020; 14:419-426. [PMID: 33337389 DOI: 10.3233/npm-200508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Timely delivery and magnesium sulfate (MgSO4) are mainstay in the treatment of preeclampsia with severe features (PWSF). Premature delivery, severity of illness and mother-infant separation may increase the risk for breastfeeding (BF) initiation failure. OBJECTIVE To compare BF initiation among women with late-onset PWSF treated with MgSO4 to women with late-onset preeclampsia without severe features (WOSF) who did not receive MgSO4. METHODS Retrospective study of 158 women with PWSF and 104 with WOSF who delivered at ≥34 weeks. Intention to BF, formula feed (FF) or partially BF was declared prenatally. At discharge, exclusive BF included direct BF or direct BF with expressed breast milk (EBM). RESULTS PWSF and WOSF groups were similar in age, race, and obstetric history. PWSF and WSOF differed in primiparity (65 & 51%), late preterm births (73 vs 15%), admission to NICU (44 &17%) and mother (5 & 4d) and infant (6 & 3d) hospital stay. Both groups were similar in intention to BF (80 & 84%), to FF (16 & 13%) and to partially BF (5 & 5%). At discharge, exclusive BF (37 & 39%), partial BF (33 & 31%) and FF (30 & 30%) were similar. Exclusive BF in the PWSF group was 43% direct BF, 28% direct BF and EBM and 29% EBM alone whereas in the WOSF group exclusive BF was 93% direct BF and 7% direct BF and EBM. CONCLUSION BF initiation rates for women with PWSF and WOSF were similar. EBM alone or with direct BF enabled infants in the PWSF group to exclusively BF at discharge.
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Affiliation(s)
- L Cordero
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M R Stenger
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M B Landon
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C A Nankervis
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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16
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Francis J, Mildon A, Stewart S, Underhill B, Tarasuk V, Di Ruggiero E, Sellen D, O'Connor DL. Vulnerable mothers' experiences breastfeeding with an enhanced community lactation support program. MATERNAL & CHILD NUTRITION 2020; 16:e12957. [PMID: 31984642 PMCID: PMC7296823 DOI: 10.1111/mcn.12957] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 01/24/2023]
Abstract
The Canada Prenatal Nutrition Program (CPNP) provides a variety of health and nutrition supports to vulnerable mothers and strongly promotes breastfeeding but does not have a formal framework for postnatal lactation support. Breastfeeding duration and exclusivity rates in Canada fall well below global recommendations, particularly among socially and economically vulnerable women. We aimed to explore CPNP participant experiences with breastfeeding and with a novel community lactation support program in Toronto, Canada that included access to certified lactation consultants and an electric breast pump, if needed. Four semistructured focus groups and 21 individual interviews (n = 46 women) were conducted between September and December 2017. Data were analysed using inductive thematic analysis. Study participants reported a strong desire to breastfeed but a lack of preparation for breastfeeding-associated challenges. Three main challenges were identified by study participants: physical (e.g., pain and low milk supply), practical (e.g., cost of breastfeeding support and maternal time pressures), and breastfeeding self-efficacy (e.g., concern about milk supply and conflicting information). Mothers reported that the free lactation support helped to address breastfeeding challenges. In their view, the key element of success with the new program was the in-home visit by the lactation consultant, who was highly skilled and provided care in a non-judgmental manner. They reported this support would have been otherwise unavailable due to cost or travel logistics. This study suggests value in exploring the addition of postnatal lactation support to the well-established national CPNP as a means to improve breastfeeding duration and exclusivity among vulnerable women.
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Affiliation(s)
- Jane Francis
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Alison Mildon
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
| | - Stacia Stewart
- Health Promotion & Community EngagementParkdale Queen West Community Health CentreTorontoOntarioCanada
| | - Bronwyn Underhill
- Health Promotion & Community EngagementParkdale Queen West Community Health CentreTorontoOntarioCanada
| | - Valerie Tarasuk
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Erica Di Ruggiero
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Daniel Sellen
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Joannah and Brian Lawson Centre for Child NutritionUniversity of TorontoTorontoOntarioCanada
| | - Deborah L. O'Connor
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoOntarioCanada
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17
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Washio Y, Collins BN, Hunt-Johnson A, Zhang Z, Herrine G, Hoffman M, Kilby L, Chapman D, Furman LM. Individual breastfeeding support with contingent incentives for low-income mothers in the USA: the 'BOOST (Breastfeeding Onset & Onward with Support Tools)' randomised controlled trial protocol. BMJ Open 2020; 10:e034510. [PMID: 32554737 PMCID: PMC7304794 DOI: 10.1136/bmjopen-2019-034510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION National breastfeeding rates have improved in recent years, however, disparities exist by socioeconomic and psychosocial factors. Suboptimal breastfeeding overburdens the society by increasing healthcare costs. Existing breastfeeding supports including education and peer support have not been sufficient in sustaining breastfeeding rates especially among low-income women. The preliminary outcomes of contingent incentives for breastfeeding in addition to existing support show promising effects in sustaining breastfeeding among mothers in the Special Supplemental Nutrition Programme for women, infants and children (WIC). METHODS AND ANALYSIS This trial uses a parallel randomised controlled trial. This trial is conducted at two sites in separate states in the USA. Mothers who were enrolled in WIC and initiated breastfeeding are eligible. Participants (n=168) are randomised into one of the two study groups: (1) standard care control (SC) group consisting of WIC breastfeeding services plus home-based individual support or (2) SC plus breastfeeding incentives (SC +BFI) contingent on demonstrating successful breastfeeding. All participants receive standard breastfeeding services from WIC, home-based individual support and assessments. Participants in SC receive financial compensation based on the number of completed monthly home visits, paid in a lump sum at the end of the 6-month intervention period. Participants in SC +BFI receive an escalating magnitude of financial incentives contingent on observed breastfeeding, paid monthly during the intervention period, as well as bonus incentives for selecting full breastfeeding food packages at WIC. The primary hypothesis is that monthly incentives contingent on breastfeeding in SC +BFI will significantly increase rates of any breastfeeding compared with SC. The primary outcome is the rate of any breastfeeding over 12 months. Randomisation is completed in an automated electronic system. Staff conducting home visits for support and assessments are blinded to study groups. ETHICS AND DISSEMINATION The Advarra Institutional Review Board has approved the study protocol (Pro00033168). Findings will be disseminated to our participants, scientific communities, public health officials and any other interested community members. TRIAL REGISTRATION NUMBER NCT03964454.
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Affiliation(s)
- Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Bradley N Collins
- College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Alison Hunt-Johnson
- College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Zugui Zhang
- Value Institute, Christiana Care Health System, Newark, Delaware, USA
| | - Gail Herrine
- Obstetrics and Gynecology Department, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Matthew Hoffman
- Obstetrics and Gynecology Department, Christiana Care Health System, Newark, Delaware, USA
| | - Linda Kilby
- N.O.R.T.H., Inc-Philadelphia WIC program, Philadelphia, Pennsylvania, USA
| | - Donna Chapman
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, Massachusetts, USA
| | - Lydia M Furman
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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18
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Dietrich Leurer M, McCabe J, Bigalky J, Mackey A, Laczko D, Deobald V. "We Just Kind of Had to Figure It Out": A Qualitative Exploration of the Information Needs of Mothers Who Express Human Milk. J Hum Lact 2020; 36:273-282. [PMID: 31710816 DOI: 10.1177/0890334419883203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Human milk expression, primarily by pump, is practiced by the majority of breastfeeding mothers in affluent countries. Existing literature is focused on determining prevalence and duration rates and the factors behind this trend. There is less research exploring mothers' perspectives and experiences related to expression. RESEARCH AIM To gather the experiential wisdom of mothers with a focus on their information needs and sources related to human milk expression. METHODS Audiotaped interviews were conducted with 35 mothers of infants, aged birth to 24 months, who had expressed milk at least once in western Canada. This study was guided by interpretive description, an applied qualitative research approach. RESULTS Registered nurses and international board-certified lactation consultants were the most common sources of information, with Internet, friends/family, and other mothers also important. Inconsistent expression advice was confusing for participants, and many reported health care providers did not address all their expression learning needs. Desired topic areas included practical advice on how to express, determining expression frequency/timing/duration, milk storage guidelines, the influence of expression on milk supply, product information, and general support/encouragement. CONCLUSIONS Assessment of expression learning needs should be part of routine lactation support at each encounter. Nonjudgmental, factual guidance will assist mothers in making evidence-informed decisions related to expression practices that are consistent with their unique breastfeeding goals. This should be supplemented by reputable online resources that provide timely and accurate information as well as efforts to connect mothers with peer support groups.
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Affiliation(s)
| | - Janet McCabe
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
- University of Ontario Institute of Technology
| | - Jodie Bigalky
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
| | - April Mackey
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
| | - Dana Laczko
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
- Saskatchewan Polytechnic
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19
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Strauch L, Sweet L, Scott H, Müller A. Mechanisms of support for exclusive breastmilk expressers in the community: a scoping review. BMC Pregnancy Childbirth 2019; 19:511. [PMID: 31856734 PMCID: PMC6923915 DOI: 10.1186/s12884-019-2667-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization recommends that infants be exclusively breastfed until the age of six months. Breastfeeding is generally understood to mean the provision of human breastmilk to the infant by direct feeding at the breast, and interventions aimed at supporting exclusive breastfeeding are therefore targeted at this activity. However, breastfeeding is actually an umbrella term covering the provision of breastmilk to an infant by any means. Our population of interest is mothers who exclusively feed their infants indirectly using expressed breastmilk. Some research suggests that any expressing, and exclusively expressing in particular, can be a risk factor for early cessation of exclusive breastmilk provision, so we were interested to identify whether any specific support existed for exclusively expressing mothers outside of the context of premature infants and the Neonatal Intensive Care Unit setting. Methods A scoping review following the Joanna Briggs Institute approach was used to explore the phenomenon of formal and informal supports in the community for exclusively expressing mothers. Searches were run across academic databases and of government websites and infant feeding support organisations. Finally, an informal internet search was run using a simple search string. Results On analysis of results, there were no studies or articles that met the search criteria. An informal internet search linked us directly with websites and blogs that could be considered a form of support intervention. These informal results suggest that support material or programs could possibly exist in other modalities but we cannot find them in the context of this type of scoping review. Conclusions The results of the search corroborated what we had suspected – that exclusively expressing mothers are not specifically supported by usual channels for new parents and that it is also difficult to find acknowledgement that exclusive expression exists. The absence of results demonstrates the relevance of this study: exclusively expressing mothers are an under-served population. If we wish to strive towards achievement of World Health Organization breastfeeding goals, exclusively expressing mothers require targeted support to assist in their infant feeding experience, and there is little formal evidence of it currently being provided.
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Affiliation(s)
- Leah Strauch
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University and Western Health Partnership, 221 Burwood Hwy, Burwood, VIC, 3125, Australia. .,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Hayley Scott
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amanda Müller
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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20
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Francis J, Dickton D. Physical Analysis of the Breast After Direct Breastfeeding Compared with Hand or Pump Expression: A Randomized Clinical Trial. Breastfeed Med 2019; 14:705-711. [PMID: 31483146 DOI: 10.1089/bfm.2019.0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Expressing human milk using commercially available pumps has increased. Most women use mechanical means to transfer their milk at some point during lactation. Yet, there is very little quantification of any breast tissue changes that occur when using mechanical devices to facilitate milk transfer. Objective: Women comfortable with breastfeeding were recruited to participate in a study to measure physical changes of the breast with a variety of human milk transfer modalities under close observation. Materials and Methods: Direct breastfeeding with their infant, hand expression, and mechanical milk transfer using two commonly available breast pumps were utilized over four milk transfer sessions with each participant. Each participant directly breastfed on the first milk transfer session and the remaining modalities were randomized. Measurements were taken before and after each modality using digital calipers. Participants completed a modified pain scale after each observation. Measurements taken after breastfeeding were used as the control for data interpretation for each participant. After a 20-minute rest period, breast tissue was again examined, and tissue appearance was recorded. Within-subject modality differences were calculated, and paired analysis mean difference and standard error of the mean are presented. Results: Fifty eligible women were approached with 92% participating. The "before" measurements were not significant for all the modalities. The "after" measurements were significantly different at p < 0.003 for breast pumps but not for breastfeeding or hand expressing. Many participants indicated pain with pumping. Conclusion: Mechanical pump use correlated with significantly increased length and diameter of the nipple compared with the post-breastfeeding and hand expressing dimensions. Pump use correlated with significant pain scores and resulted in localized inflammatory changes. Understanding how pumps affect breast tissue is helpful in improving experiences with breast pumps and may improve breastfeeding outcomes. Additional research is needed to better understand ramifications of long-term use of breast pumps.
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Affiliation(s)
- Jimi Francis
- Department of Health & Kinesiology, University of Texas at Tyler, Tyler, Texas
| | - Darby Dickton
- CAPT, USAF 60 AMC SGCS, University of California, Davis - Health System, Sacramento, California
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21
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Whitfield KC, Ventura AK. Exploration of Responsive Feeding During Breastfeeding Versus Bottle Feeding of Human Milk: A Within-Subject Pilot Study. Breastfeed Med 2019; 14:482-486. [PMID: 31188021 DOI: 10.1089/bfm.2019.0069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Responsive feeding promotes optimal feeding patterns and growth trajectories. Breastfeeding is thought to facilitate responsive feeding, but research to date has been limited to comparing formula-feeding and breastfeeding dyads. Using a within-subject approach, we aimed to assess maternal responsiveness to infant cues during two human milk feeding sessions differing by feeding modality (breastfeeding versus bottle feeding). Materials and Methods: Nine mother-infant dyads (infants ≤6 months) were recruited from the Halifax Regional Municipality, Nova Scotia, from April to May 2018. Two human milk-feeding sessions, directly from the breast and from a bottle, were video-recorded in participants' homes, then scored using the validated Nursing Child Assessment Satellite Training (NCAST) Caregiver/Parent-Child Interaction Feeding Scale. The second half of feeding sessions were coded for infant satiation cues. Results: All women earned a college degree or higher, and were partnered. Mothers were aged mean ± standard deviation 33.2 ± 4.0 years; infants were 14.6 ± 6.9 weeks old and six (67%) were female. Mothers were more sensitive to infant cues during breastfeeding (NCAST Maternal Sensitivity to Cues sub-scale score, 15.0 ± 1.0) than bottle feeding (13.4 ± 1.6; p = 0.016). There was a significantly longer latency from feeding session midpoint to the first satiation cue during breastfeeding (minutes:seconds; 3:00 ± 1:53 versus 0:45 ± 1:18 bottle feeding, p = 0.038). There was no difference in the number of infant cues by feeding modality. Conclusions: Despite the small sample with high socioeconomic status, this pilot study highlights differences in maternal responsiveness to infant cues by feeding modality with human milk, which warrants further investigation.
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Affiliation(s)
- Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Canada
| | - Alison K Ventura
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California
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22
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Yourkavitch J, Chetwynd EM. Toward Consistency: Updating Lactation and Breastfeeding Terminology for Population Health Research. J Hum Lact 2019; 35:418-423. [PMID: 31206312 DOI: 10.1177/0890334419851488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has, historically, been a lack of consistency in the use and definition of terms and their associated measurement in breastfeeding research. The purpose of this paper is to promote consistency through a taxonomy and lexicon for population-based breastfeeding research with the modern nursing dyad. The taxonomy organizes concepts in categories related to research on feeding human milk to infants, noting the perspective from the provider of human milk (parent or alloparent) and the receiver of human milk (child). The taxonomy includes these categories: psychology, physiology, behavior, and modality. The intensity of behaviors and modalities can be characterized qualitatively or quantitatively. Other terms are introduced or defined for the modern era and measurement standards are posed. These suggestions invite discussion and debate, in an effort to move researchers toward consistent measurement, documentation, and presentation, to build a credible evidence base for breastfeeding and practices related to the provision and consumption of human milk.
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Affiliation(s)
- Jennifer Yourkavitch
- 1 University of North Carolina at Greensboro, School of Health and Human Sciences, Department of Public Health Education, Center for Women's Health and Wellness, Greensboro, North Carolina, USA
| | - Ellen M Chetwynd
- 1 University of North Carolina at Greensboro, School of Health and Human Sciences, Department of Public Health Education, Center for Women's Health and Wellness, Greensboro, North Carolina, USA.,2 North Carolina State University, College of Agriculture and Life Science, Department of Food, Bioprocessing and Nutrition Sciences, Raleigh, North Carolina, USA
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23
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Jardine FM. Breastfeeding Without Nursing: "If Only I'd Known More about Exclusively Pumping before Giving Birth". J Hum Lact 2019; 35:272-283. [PMID: 29979622 DOI: 10.1177/0890334418784562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Human milk is understood to be the optimal nutrition for infants, yet many women struggle to nurse. Although exclusively pumping human milk can provide a solution, women may be unaware of this possibility and, thus, experience unnecessary frustration. RESEARCH AIM This study aimed to (a) determine the proportion of respondents who had heard of exclusive pumping prenatally; (b) describe sources that respondents turned to and/or received breastfeeding-related information from prenatally; (c) explore the ways in which respondents learned prenatally about exclusive pumping; (d) describe how useful respondents found various information sources when learning about exclusive pumping; and (e) describe the differences between respondents who first heard the term exclusive pumping prenatally versus postpartum. METHODS A cross-sectional, self-report, mixed-methods survey was administered online to a convenience sample of current and/or past exclusive pumpers ( N = 1,215). Descriptive statistics were produced (Research aims 1-4), and chi-square tests (Research aims 1, 2, and 5) and a Mann-Whitney U test (Research aim 5) were conducted, to identify trends and compare respondents. RESULTS Seventy-one percent ( n = 864) of respondents had not heard of exclusive pumping until after giving birth. Respondents reported that very few prenatal breastfeeding information sources mentioned or explained exclusive pumping. Women who had heard about exclusive pumping prior to giving birth ( n = 291, 24%) reported feeling more knowledgeable about how to exclusively pump and less frustrated, insecure, depressed, rejected, embarrassed, envious, burdened, guilty, and disappointed while exclusively pumping. CONCLUSION For postpartum knowledge and affective outcomes to improve, prenatal infant feeding information and education must include information about exclusive pumping.
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Affiliation(s)
- Fiona M Jardine
- 1 College of Information Studies, University of Maryland, College Park, MD, USA
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24
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McInnes RJ, Gillespie N, Crossland N, Hall Moran V, Hoddinott P. Women's views about a free breast pump service: Online survey informing intervention development. MATERNAL & CHILD NUTRITION 2019; 15:e12745. [PMID: 30381867 PMCID: PMC7198920 DOI: 10.1111/mcn.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
Improving breastfeeding outcomes is a global priority; however, in the United Kingdom, continuation of breastfeeding remains low. Growing empirical evidence suggests a free breast pump service might be an acceptable and feasible incentive intervention to improve breastfeeding outcomes and reduce heath inequalities. To inform intervention development, we conducted an online survey with women recruited via social media using snowball sampling. Data were analysed descriptively (closed questions) with qualitative thematic analysis (free text). The survey was completed by 666 women, most of whom had recently breastfed and used a breast pump. Participants agreed that free pump hire (rental/loan; 567 women; 85.1%) or a free pump to keep (408; 61.3%) should be provided. Free text comments provided by 408 women (free pump) and 309 women (free hire) highlighted potential benefits: helping women to continue breastfeeding; express milk; overcome difficulties; and pump choice. Concerns are possible effect on breast milk supply, reduced breastfeeding, pumps replacing good support for breastfeeding, and pump hire hygiene. Personal and societal costs are important issues. Some suggested a pump service should be for low-income mothers, those with feeding difficulties or sick/preterm infants. A one-size service would not suit all and vouchers were proposed. Some suggested fees and deposits to prevent waste. To our knowledge, this is the first study reporting views about the acceptability of providing a free breast pump hire service. Mothers support and wish to have a say in breast pump service development. Future evaluations should address impact on feeding outcomes, professional support, hygiene for hired pumps, and costs.
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Affiliation(s)
- Rhona J. McInnes
- Associate Professor in Maternal Health & Consultant Midwife for NHS Lothian, School of Health and Social CareEdinburgh Napier University (ENU)EdinburghScotland
| | - Nicola Gillespie
- Research Midwife, Nursing Midwifery Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowScotland
| | - Nicola Crossland
- Research Associate, Maternal and Infant Nutrition and Nurture Unit, College of Health and WellbeingUniversity of Central LancashirePrestonUK
| | - Victoria Hall Moran
- Associate Professor, Maternal and Infant Nutrition and Nurture Unit, College of Health and WellbeingUniversity of Central LancashirePrestonUK
| | - Pat Hoddinott
- Chair in Primary Care, Nursing Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirlingUK
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25
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Yamada R, Rasmussen KM, Felice JP. "What Is 'Enough,' and How Do I Make It?": A Qualitative Examination of Questions Mothers Ask on Social Media About Pumping and Providing an Adequate Amount of Milk for Their Infants. Breastfeed Med 2018; 14:17-21. [PMID: 30431317 PMCID: PMC6352550 DOI: 10.1089/bfm.2018.0154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Mothers commonly cite an inadequate milk "supply" as a reason for stopping human milk feeding. Further, pumping may affect mothers' understanding of their milk production. We aimed to characterize the questions mothers ask each other online related to the adequacy of the milk they pumped and provided to their infants. MATERIALS AND METHODS We conducted a secondary analysis of 543 posts containing questions related to pumping on an online discussion forum. These posts were provided by an open cohort of ∼25,000 women between 1 month before due date and 4.5 months postpartum. We used thematic analysis with Atlas.ti to analyze the posts. RESULTS Mothers commonly asked how many ounces they should be pumping and inquired about strategies to increase their pump output. They also wondered how many ounces or bottles of pumped milk they should provide to their infants or store for future use. Finally, mothers reported the inadequacy of the milk they were pumping or providing to their infants as potential reasons for stopping human milk feeding. CONCLUSION Our findings suggest that mothers may benefit from additional guidance from health care providers on the limitations of using pumps to draw conclusions about their milk production, the current evidence related to the use of herbal galactagogues, and the importance of responsive infant feeding. These findings also highlight the need for future research into how pumping or using herbal galactagogues may affect mothers' actual or perceived milk production and how styles for providing pumped milk compare to styles for feeding directly at the breast.
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Affiliation(s)
- Rei Yamada
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | | | - Julia P. Felice
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
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Yourkavitch J, Rasmussen KM, Pence BW, Aiello A, Ennett S, Bengtson AM, Chetwynd E, Robinson W. Early, regular breast-milk pumping may lead to early breast-milk feeding cessation. Public Health Nutr 2018; 21:1726-1736. [PMID: 29433598 PMCID: PMC6657516 DOI: 10.1017/s1368980017004281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the effect of early, regular breast-milk pumping on time to breast-milk feeding (BMF) and exclusive BMF cessation, for working and non-working women. DESIGN Using the Infant Feeding Practices Survey II (IFPS II), we estimated weighted hazard ratios (HR) for the effect of regular pumping (participant defined) compared with non-regular/not pumping, reported at month 2, on both time to BMF cessation (to 12 months) and time to exclusive BMF cessation (to 6 months), using inverse probability weights to control confounding. SETTING USA, 2005-2007. SUBJECTS BMF (n 1624) and exclusively BMF (n 971) IFPS II participants at month 2. RESULTS The weighted HR for time to BMF cessation was 1·62 (95 % CI 1·47, 1·78) and for time to exclusive BMF cessation was 1·14 (95 % CI 1·03, 1·25). Among non-working women, the weighted HR for time to BMF cessation was 2·05 (95 % CI 1·84, 2·28) and for time to exclusive BMF cessation was 1·10 (95 % CI 0·98, 1·22). Among working women, the weighted HR for time to BMF cessation was 0·90 (95 % CI 0·75, 1·07) and for time to exclusive BMF cessation was 1·14 (95 % CI 0·96, 1·36). CONCLUSIONS Overall, regular pumpers were more likely to stop BMF and exclusive BMF than non-regular/non-pumpers. Non-working regular pumpers were more likely than non-regular/non-pumpers to stop BMF. There was no effect among working women. Early, regular pumpers may need specialized support to maintain BMF.
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Affiliation(s)
- Jennifer Yourkavitch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | | | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | - Allison Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | - Susan Ennett
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Angela M Bengtson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | - Ellen Chetwynd
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, NC, USA
| | - Whitney Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
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Abstract
BACKGROUND More than 85% of contemporary lactating women in the United States express their milk at least sometimes. Some produce milk exclusively through pumping. We characterized women who pumped but never fed at the breast and compared their infant feeding practices with those of women who fed at the breast with or without pumping. SUBJECTS AND METHODS Study participants were those delivered at Ohio State University Wexner Medical Center in 2011 and completed a questionnaire at 12 months postpartum (n = 478). We used bivariate and multivariate approaches (survival analysis) to compare women who pumped but never fed at the breast with women who fed at the breast with or without pumping. RESULTS Women (n = 33, 6.9%) who pumped but never fed at the breast comprised a diverse group but were more likely to have delivered preterm and were of lower socioeconomic status on average. They initiated pumping and formula feeding earlier (median = day 1 after delivery) and were more likely to report difficulty making enough milk compared with women who fed at the breast with or without pumping. They had much shorter total duration of milk production (adjusted hazard ratio = 3.3, 95% confidence interval: 2.1, 5.2) after controlling for clinical and sociodemographic confounders. CONCLUSIONS Pumping without feeding at the breast is associated with shorter milk feeding duration and earlier introduction of formula compared with feeding at the breast with or without pumping. Establishing feeding at the breast, rather than exclusive pumping, may be important for achieving human milk feeding goals.
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Affiliation(s)
- Sarah A. Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Kelly M. Boone
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Reena Oza-Frank
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Sheela R. Geraghty
- Cincinnati Children's Center for Breastfeeding Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Felice JP, Geraghty SR, Quaglieri CW, Yamada R, Wong AJ, Rasmussen KM. "Breastfeeding" without baby: A longitudinal, qualitative investigation of how mothers perceive, feel about, and practice human milk expression. MATERNAL & CHILD NUTRITION 2017; 13:e12426. [PMID: 28078789 PMCID: PMC5491350 DOI: 10.1111/mcn.12426] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/27/2022]
Abstract
Most American mothers who produce human milk (HM) now pump in place of some or all feeding at the breast, and most American infants are now fed pumped HM. We aimed to investigate mothers' perceptions of, attitudes toward, and practices for pumping and providing pumped HM. Results related to pumping are reported here. We conducted in-depth, semi-structured interviews among a diverse sample of 20 mothers who pumped, following each from pregnancy through infant HM-feeding cessation up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Mothers' reasons for pumping changed over time and reflected their needs and desires (e.g., latch difficulty, return to work, and increasing their milk supply). Mothers reported that pump type and quality were important to pumping success and that pumping was time-consuming, costly, and unpleasant compared to feeding at the breast. Regardless of how often mothers pumped, most felt pumping was necessary to meet their infant HM-feeding goals and was a welcome means of sharing with other caregivers the bonding opportunity and tasks they associated with feeding infants. Mothers interpreted output from pumping sessions to understand their ability to provide enough milk to meet their infants' needs. Mothers' reasons for pumping may signal constraints to infant HM feeding that may be addressed with policy changes. Mothers' attitudes and perceptions toward pumping indicate that, although pumping fills important and welcome roles for many mothers, the reality of its practice may make it an unacceptable or infeasible substitute for some.
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Affiliation(s)
- Julia P. Felice
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | | | | | - Rei Yamada
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Adriana J. Wong
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Demirci JR, Bogen DL. An Ecological Momentary Assessment of Primiparous Women's Breastfeeding Behavior and Problems From Birth to 8 Weeks. J Hum Lact 2017; 33:285-295. [PMID: 28418803 PMCID: PMC5512283 DOI: 10.1177/0890334417695206] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primiparous women are at risk for early, unintended breastfeeding reduction and cessation. Breastfeeding patterns that contribute to these outcomes require further exploration. Research aim: This study aimed to describe early, "real-time" breastfeeding behaviors and perceived problems of primiparous women. METHODS First-time mothers intending to exclusively breastfeed downloaded a commercial infant-feeding app during their postpartum hospitalization. Women logged feedings and their breastfeeding experiences, as they occurred, through 8 weeks postpartum. Additional feeding and background data were collected via electronic medical records and questionnaires administered at enrollment and 2 and 8 weeks postpartum. Summary statistics were compiled to examine weekly breastfeeding behaviors and problems. RESULTS In this sample of 61 primarily highly educated, White women committed to breastfeeding, 38% ( n = 23) used formula during the postpartum hospitalization and 68% ( n = 34) used formula at least once by 2 weeks. Nine women stopped breastfeeding during the study. Women using any formula in the hospital and those with less positive baseline attitudes toward breastfeeding were less likely to be exclusively breastfeeding at 2 and 8 weeks, respectively ( p < .05). There was a trend toward declining at-breast feeds and high rates of milk expression during the study. Breastfeeding problems peaked at Week 2, with 81% of women ( n = 39) endorsing at least one problem at that time. The most prevalent problems included perception of inadequate milk, pain, latching, and inefficient feeds. CONCLUSION Interventions to address suboptimal breastfeeding in primiparous women should consider the pervasiveness of early milk expression and in-hospital formula supplementation in this population, as well as the trajectory of common problems.
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Affiliation(s)
- Jill R. Demirci
- University of Pittsburgh School of Nursing, Department of Health Promotion & Development, 3500 Victoria Street, Pittsburgh, PA 15213
| | - Debra L. Bogen
- University of Pittsburgh School of Medicine, Division of General Academic Pediatrics
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Bream E, Li H, Furman L. The Effect of Breast Pump Use on Exclusive Breastfeeding at 2 Months Postpartum in an Inner-City Population. Breastfeed Med 2017; 12:149-155. [PMID: 28394660 DOI: 10.1089/bfm.2016.0160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Breastfeeding is the optimal form of infant nutrition, yet national rates are below recommendations with persistent disparities. Breast pumps may address the reasons that mothers discontinue breastfeeding. OBJECTIVES To determine whether breast pump use increases exclusive breastfeeding at 1.5-3.5 months postpartum. MATERIALS AND METHODS We reviewed charts for maternal-infant descriptors and feeding type for infants born between November 2013 and June 2014 who received any breast milk at a visit <14 days of age in our inner-city pediatric practice. We compared feeding at 1.5-3.5 months between those with breast pump and those without breast pump. RESULTS Of the 905 infants with feeding type recorded, 487 (54%) received any breast milk, of whom 355 (72.9%) had a visit at 1.5-3.5 months [95.4% African American (AA)]. Rates of any breastfeeding (93.8% vs. 38.9%) and exclusive breastfeeding (50.0% vs. 17.8%) were significantly higher in non-AAs than in AAs. Due to small numbers of non-AAs, further analyses were conducted for AAs only. The rate of exclusive breastfeeding at 1.5-3.5 months (19.4% vs. 16.3%) was similar between those with a breast pump and those without a breast pump, whereas rates of any breastfeeding were higher among those with no breast pump (46.9% vs. 31.4%, p = 0.004). Also, among AA mothers, rates of feeding at the breast were lower (21.5% vs. 44.4%, p < 0.0001) and rates of feeding expressed breast milk were higher (16.6% vs. 8.2%, p = 0.02) among those with a breast pump versus those without a breast pump. CONCLUSIONS Although breast pumps were free, breast pump use among predominantly AA WIC-eligible mothers was not associated with increased rates of exclusive breastfeeding at 1.5-3.5 months postpartum.
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Affiliation(s)
- Elise Bream
- 1 Department of Pediatrics, Rainbow Babies and Children's Hospital , Cleveland, Ohio
| | - Hong Li
- 2 Center for Clinical Investigation, Case Western Reserve University , Cleveland, Ohio
| | - Lydia Furman
- 1 Department of Pediatrics, Rainbow Babies and Children's Hospital , Cleveland, Ohio
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Oza-Frank R, Moreland JJ, McNamara K, Geraghty SR, Keim SA. Early Lactation and Infant Feeding Practices Differ by Maternal Gestational Diabetes History. J Hum Lact 2016; 32:658-665. [PMID: 27550377 PMCID: PMC6322208 DOI: 10.1177/0890334416663196] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Detailed data on lactation practices by gestational diabetes mellitus (GDM) history are lacking, precluding potential explanations and targets for interventions to improve lactation intensity and duration and, ultimately, long-term maternal and child health. OBJECTIVE This study aimed to examine breastfeeding practices through 12 months postpartum by GDM history. METHODS Women who delivered a singleton, liveborn infant at The Ohio State University Wexner Medical Center (Columbus, OH), in 2011 completed a postal questionnaire to assess lactation and infant feeding practices and difficulties. Bivariate and multivariate associations between GDM history and lactation and infant feeding practices were examined. RESULTS The sample included 432 women (62% response rate), including 7.9% who had GDM during the index pregnancy. Women with GDM initiated breastfeeding (at-the-breast or pumping) as often as women without any diabetes but were more likely to report introduction of formula within the first 2 days of life (79.4% vs 53.8%, P < .01; adjusted odds ratio: 3.48; 95% confidence interval, 1.47-8.26). Women with GDM initiated pumping 4 days earlier than women without diabetes ( P < .05), which was confirmed in adjusted analyses. There was no difference in the proportion of women reporting breastfeeding difficulty (odds ratio: 2.08; 95% confidence interval, 0.78-5.52). However, there was a trend toward women with GDM reporting more formula feeding and less at-the-breast feeding as strategies to address difficulty compared with women without diabetes. CONCLUSION Additional research is needed to understand why women with GDM engage in different early lactation and infant feeding practices, and how best to promote and sustain breastfeeding among these women.
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Affiliation(s)
- Reena Oza-Frank
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Kelly McNamara
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Sarah A. Keim
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
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