Breastfeeding Support beyond the Hospital
Anderson K, Livingston T, Labbok M
University of North Carolina at Chapel Hill, North Carolina, USA
Background: The rate of exclusive breastfeeding among mothers in low-income families remains low. The most rapid decline occurs from day 3 to 6 weeks.
Goals: Goals were to further coordination of services and consistency of messages among service providers.
Methods: Community-based participatory research included developing a stakeholder’s group, which led the direction of the study. Mothers were recruited through public health clinics to participate in mini focus groups to discuss prenatal and postpartum breastfeeding support, focusing on the first 6 weeks postpartum. Transcripts were uploaded into Atlas.ti 6.0, and responses were coded.
Results: Themes developed related to breastfeeding messages (eg, internet frequently cited as source of breastfeeding information), services (eg, number of appointments in early days postpartum not viewed as a breastfeeding challenge), breastfeeding in public, and breast pumps.
Conclusion: Women may need more coordinated breastfeeding support and pertinent messages in the early days postpartum to meet their breastfeeding goals.
A Virtual Infant Nutrition Support Clinic Improves Breastfeeding Duration and Exclusivity
da Silva O, Angelini M, Christmas M, Rai E, Geoghegan-Morphet N
University of Western Ontario, Ontario, Canada
London Health Sciences Center, Ontario, Canada
Western Michigan University, Michigan, USA
Canadian Lactation Consultants Association, Saskatchewan, Canada
Background: Despite high breastfeeding initiation rates, the majority of Canadian babies are not exclusively breastfed for the recommended first 6 months of life.
Goals: A pilot trial was conducted to evaluate the effect of an online breastfeeding program that combined peer and professional support along with education resources.
Methods: Mothers were given access to the Maternal Virtual Infant Nutrition Support (MAVINS) website, which provides written and video resources on breastfeeding topics as well as a discussion forum facilitated by an International Board Certified Lactation Consultant. Mothers were also emailed weekly breastfeeding tips.
Results: MAVINS mothers had significantly higher exclusive breastfeeding and any-breastfeeding rates at 6 months postpartum compared to provincial peers. Breastfeeding exclusivity was correlated with MAVINS logins. More than half of the mothers enrolled in MAVINS reported that the resource helped “a lot” or “completely,” and the more a mother accessed MAVINS, the more likely she was to report satisfaction with the resource.
Using Video Communication in an NP-Led Clinic to Assess and Treat Women with Mastitis
Watson J
Sunnybrook Health Sciences Centre, Ontario, Canada
Background: Mastitis is an inflammatory condition of the breast, usually associated with lactation, and may or may not be accompanied by infection (WHO, 2000)[PE: Can this citation be removed?]. Many women seen in our breastfeeding clinic are clinically unwell and have traveled to the clinic with a young baby and incurred transportation costs and wait times to be assessed by the nurse practitioner (NP). Early assessment and treatment are key to protecting breastfeeding and preventing complications, yet it can be challenging for women to seek timely care to facilitate early treatment to protect breastfeeding.
Goal: Consideration was given to providing assessment and treatment to women using internet-based video communication. The motivation to evaluate this approach was to create a more woman-centered, cost-effective, and efficient approach to care.
Method: Working closely with the hospital’s privacy officer and using an application called VSee,© a pilot program was developed to conduct the NP clinic visit with women using video technology for assessment and diagnosis.
Results: No difficulties have been experienced with assessment or diagnosis using video communication. Each visit saves the woman approximately 1 to 2 hours of travel time and $30 in transportation costs. Women appreciate the convenience of video technology.
Conclusion: As technology is used increasingly in health care, health care providers have a key role to implement and evaluate care provided through video communication to determine the accuracy of assessments, equivalency of outcomes, and accessibility and acceptability of care.
Maternal Report of Exclusive Breastfeeding after Interdisciplinary Intervention
Miller J
Anglo-European College of Chiropractic, Bournemouth, UK
Background: Little research has been done on interdisciplinary interventions for suboptimal breastfeeding.
Goals: This study aimed to evaluate rates of exclusive breastfeeding outcomes along with maternal satisfaction of care from a university-affiliated interdisciplinary breastfeeding clinic incorporating midwives and chiropractors.
Methods: The author conducted a service evaluation at intake and 12-week follow-up after a single session intervention.
Results: Eighty-five initial questionnaires were completed and 72 (85%) postal questionnaires were returned. On follow-up, 93% of mothers reported an improvement in feeding as well as high satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% were. The relative risk ratio for exclusive breastfeeding after attending the clinic was 3.6 (95% confidence interval, 2.4-5.4).
Conclusion: The rate of exclusive breastfeeding following the midwife/chiropractic intervention was substantially higher than UK averages, and mothers were almost 4 times as likely to exclusively breastfeed after the clinical intervention. Further higher quality studies are required.
An Ecological Momentary Assessment of Primiparous Women’s Breastfeeding Behavior and Problems from Birth to 8 Weeks
Demirci J
University of Pittsburg, Pennsylvania, USA
Background: Ecological momentary assessment (EMA) permits accurate and detailed characterization of breastfeeding behavior.
Goal: This study aimed to describe weekly breastfeeding patterns of first-time mothers through 8 weeks postpartum using EMA via a mobile app.
Methods: Sixty-one healthy, primiparous women tracked infant feeding, milk expression, and breastfeeding thoughts daily for 8 weeks via a commercial infant feeding app. We condensed, tabulated, and calculated summary statistics for data weekly.
Results: Despite participants’ intentions to exclusively breastfeed, 36% supplemented with formula in-hospital and 74% supplemented with formula before 8 weeks. Seventy-one percent initiated pumping within the first 2 weeks. Women identified more than 45 types of breastfeeding problems that waxed and waned by week; pain and perception of inadequate milk were top concerns that spanned the entire 8 weeks and peaked at week 2.
Conclusion: These EMA data can be used to strategize placement of anticipatory breastfeeding guidance and breastfeeding support interventions for first-time mothers.
Acculturation and Breastfeeding: Challenges and Finding Solutions
Scott A, Shreve M, Britni A, McElfish P
University of Arkansas, Arkansas, USA
Background: The role of immigrant status in understanding socioeconomic disparities has not been well studied. Recent research reveals that cultural differences and acculturation affect breastfeeding duration rates among immigrant mothers.
Goal: This pilot study aimed to investigate the breastfeeding experiences of Pacific Islander mothers to evaluate factors affecting breastfeeding initiation and duration rates. It served as the basis for an education intervention study during late 2015 and early 2016.
Method: This qualitative study used a written questionnaire and focus groups during 2015 in an area that is home to the largest population of Marshallese in the continental United States.
Results: Public shaming, perceived insufficient milk supply, decreased social support, and disempowerment were primary themes affecting breastfeeding rates. Breastfeeding “experts,” such as Special Supplemental Nutrition Program for Women, Infants, and Children personnel, were perceived as supportive but negatively influenced breastfeeding confidence due to the perception of formula as superior and the maternal diet as inadequate.
Practices Supporting Breastfeeding in the NICU: A National Survey
Nottingham E, O’Donoghue C
James Madison University, Virginia, USA
Background: Although literature reports practices influencing successful breastfeeding for babies in neonatal intensive care units (NICUs), significant variations persist across US hospitals. Current practices merit investigation.
Goals: This survey aimed to empirically assess NICU breastfeeding practices.
Methods: An institutional review board–approved survey was deployed electronically to medical directors (and their designees) of US neonatal-perinatal training programs (N = 98).
Results: The response rate was 32%, representing level 3 to 4 NICUs. All respondents used behavioral cues to guide oral feeding initiation, although only 58% used the baby’s cues to guide scheduled feedings. Nutritive oral stimulation was introduced from 22 to 34 weeks gestational age. For mothers wishing to breastfeed, 61% was the first oral feeding offered, 97% received a lactation consult, 52% prevention of formula use, and 87% had a donor milk policy.
Conclusion: Although results suggest advancements in breastfeeding support in NICUs, outdated and disparate practices persist. Supplemental qualitative investigation of these variants is advised.
Effect of Storage Time on Some Chemical Components of Human Breast Milk
Ahmad G, Elzayat T
National Nutrition Institute, Cairo, Egypt
Al Azhar University, Cairo, Egypt
Background: Human milk is uniquely superior for infant feeding and is species specific, in addition to its unique immunological, growth, and developmental benefits.
Goal: The authors studied the effect of storage of breast milk on total fat, total protein and lactose, and vitamin C, A, and E concentration by analysis of 3 breast milk samples collected from 20 healthy lactating mothers.
Method: The first sample was analyzed immediately, the second was stored in the refrigerator (4°C to 6°C) for 24 hours, and the third was stored in the freezer (–4°C to −8°C) for 1 week.
Results: Statistically significant decreases in vitamin C and A concentrations occurred in the second sample. Statistically significant decreases in lactose content and vitamin C, A, and E concentrations were found in the third sample.
The Effect of Different Techniques of Breast Milk Expression on its Fat Content in Mothers of Preterm Infants
Ahmad G, Korraa A
National Nutrition Institute, Cairo, Egypt
Al Azhar University, Cairo, Egypt
Background: Breastfeeding preterm infants presents unique challenges that include establishing and maintaining a milk supply.
Goal: This study aimed to compare the effect of different techniques of breast milk expression on the fat content of human milk.
Method: The authors tested hand technique alone and mechanical pumping alone and in combination with Hand on Pump (HOP) in lactating mothers (N = 50) of preterm infants age 7 to 14 days, with a gestational age at birth ranging from 30 to 36 weeks. Each mother used all 3 types of milk expression.
Results: The HOP technique led to a higher fat content than the other 2 methods. The breast milk fat content increased with mothers’ parity. It was inversely related to mothers’ age and was not affected by mothers’ body mass index.
Conclusion: The HOP technique is more effective in increasing fat content.
The Effect of a Breastfeeding Support Program for Hospital Employees on the Exclusive Breastfeeding Rate at 6 Months: 10 Years of Experience
Thavonvattana S, Somdam H, Sermkij J, Sawasdivorn S, Luanpan S, Sasom U, Thussanasupap B
Queen Sirikit National Institute of Child Health, Thailand
Background: Queen Sirikit National Institute of Child Health is the tertiary care hospital for children in Thailand. Almost 95% of all employees are women with approximately 40 babies delivered each year. Before 2006, there was no breastfeeding support in the institute and no one exclusively breastfed her child for even 4 months.
Goals: This study aimed to (1) implement a breastfeeding support program for hospital employees and (2) support and empower hospital employees to achieve a 6-month exclusive breastfeeding goal.
Methods: The data were collected from 2006 to 2015; hospital employees (N = 249) participated in this program. The breastfeeding support program for hospital employees includes (1) helping them to gain a positive attitude and breastfeeding knowledge during the prenatal period through the breastfeeding seminar, (2) visiting hospital employees at the postpartum ward and providing a breastfeeding gift set, (3) providing convenient access to lactation nurses for consulting (at clinic/call center/smart phone application), (4) providing breastfeeding breaks for 30 minutes, 2 times a day, (5) loaning double electric breast pumps, and (6) providing a daycare facility in the institute.
Results: The results found that the exclusive breastfeeding rates at 6 months from 2006 to 2010 were 52.17%, 36.84%, 63.64%, 68.18%, 66.67%, 60.87%, 76.92%, 68.18%, 73.33%, and 72.97%, respectively. The key success factors include (1) arranging the breastfeeding seminar during the prenatal period regularly, (2) providing individual support during the postpartum period, (3) ensuring that hospital employees had adequate milk supply before discharge from the hospital, and (4) ensuring that hospital employees received continuous supervision, support, and counseling.
Conclusion: The breastfeeding support program for hospital employees was an effective program that should be implemented in other hospitals.
Effectiveness of Combined Breastfeeding Support from Health Personnel on Exclusive Breastfeeding
Yimyam S
Chiang Mai University, Chiang Mai, Thailand
Background: In Thailand, most mothers fail to reach the recommended exclusive breastfeeding goal of at least 6 months.
Goal: The objective of this quasi-experiment study was to compare exclusive breastfeeding at 6 months between mothers before and those after a breastfeeding support intervention.
Method: The intervention was a combination of breastfeeding supports, including prenatal and postnatal periods at the antenatal clinic, in the postpartum ward, in the lactation and well-baby clinic, and in the health promotion section. The mothers (N = 837) were interviewed about breastfeeding practices before the implementation, whereas 1201 mothers were interviewed after. Data were analyzed by using chi-square test.
Results: The results revealed that exclusive breastfeeding rates at 6 months after implementation of the combined breastfeeding supports were significantly higher than rates before, at the level of .001 (44.63% vs 37.16%; chi-square = 11.34).
Conclusion: The results suggest that this intervention should be encouraged to be used in every health care facility for healthy children.
