Journal of Human Lactation

Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers.

To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh.

A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors’ influence on breastfeeding practices.

Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed.

Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

A human-milk-based diet is the best option for nutritional therapy for preterm and/or sick newborns.

The study aims were to restructure the reimbursement rates to hospitals in Poland for infants’ tube feedings to favor the use of donor human milk over formula for newborns who required supplementation of expressed mother’s milk and evaluate the results of the financing change during the first year of implementation (2018).

Financial data from hospitals were collected (2015–2016) by the Human Milk Bank Foundation using a data sheet designed by the Agency for Health Technology Assessment and Tariff System. We used data to restructure the reimbursement rates to hospitals for infants’ tube feedings and implemented the changes in late 2017. The National Health Fund was requested to share reported data in 2018 concerning tube feeding services.

More than half (61%) of NICUs introduced human milk tube feeding for newborns. It was provided to participants (N = 5,530), most frequently to seriously ill preterm infants (66.6%). Of these infants, 2,323 were fed donor human milk. Only 1,925 newborns received formula tube feeding. However, there were large differences in frequency of services reported among various parts of the country.

Based on our knowledge, Poland is the only European country where the reimbursement cost for human-milk-based nutritional therapy has been implemented in a manner intended to increase the quality of health care services for preterm newborns. Equal reimbursement for expressed mother’s milk and donor milk did not appear to cause overuse of donor milk based on our analysis of the 2018 data.

With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking.

We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China.

The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model.

The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0–5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]).

The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

African Americans breastfeed less than other groups, which has implications for health throughout the life course. Little is known about mobile health technologies to support breastfeeding.

This study proceeded in two phases. The aim of Phase 1 was to identify ideal technological components and content of a mobile health intervention. The aim of Phase 2 was to determine the usability of a prototype, KULEA-NET, based on the Phase 1 findings.

For this mixed-methods study, we used community-based participatory research methods and user-centered technology design methods. We used open coding in NVivo 11 to organize data from focus groups and in-depth interviews, then we analyzed the data. We then developed a prototype and tested the prototype’s usability with the System Usability Scale. Fifty pregnant and postpartum African Americans from the District of Columbia participated.

Participants preferred an app with text messaging technology and identified areas for intervention: self-efficacy, parent-child attachment beliefs, social support, public breastfeeding and social desirability, and returning to work. Desired features included local resources, support person access, baby care logs, identification of public breastfeeding venues, and peer discussions. The System Usability Scale score was 73.8, which indicates above average usability.

A mobile health technology like KULEA-NET can be used to meet the breastfeeding needs of African Americans, build social desirability, and complement traditional health care. The appeal of an African American-specific intervention is unclear. Responding to mixed feeding practices is challenging. KULEA-NET is a mobile breastfeeding intervention guided by the preferences of African American parents and offers promising usability metrics.

Although exclusive breastfeeding of infants has several benefits, in Ghana only 52% of children under 6 months old are breastfed exclusively. However, researchers have not conducted longitudinal observational studies to examine exclusive breastfeeding discontinuation and determine risk factors.

(1) To determine exclusive breastfeeding discontinuation, and (2) to examine those factors linked to discontinued exclusive breastfeeding.

A longitudinal, one-group observational study was conducted. A total of 322 mothers who had normal and full-term delivery at a district level referral hospital from January to December 2017 were recruited, followed-up every month, and subsequently interviewed after 6 months postpartum. Data were collected using validated questionnaires. Binary and multivariable Poisson regression analyses were the statistical analytical methods used.

Respondents’ mean age was 29.78 years (SD = 5.20). Among the 322 mothers who initiated breastfeeding with human milk at birth, 108 (34%) discontinued exclusive breastfeeding before 6 months postpartum. After controlling for possible covariates, attending antenatal care 4 or less times during pregnancy (aRR = 6.54; 95% CI [1.77–24.22]; p = .005); lack of support from family to breastfeed exclusively (aRR = 2.41; 95% CI [1.23–4.71]; p = .010), outside pressure to provide other food to the baby < 6 months postpartum (aRR = 1.87; 95% CI [1.01–3.46]; p = .045), and living in an urban area (aRR = 2.10; 95% CI [1.17-3.75]; p = .013) significantly increased the risks of discontinuing exclusive breastfeeding.

Universal exclusive breastfeeding may not be achieved without tackling the key determinants of discontinuation of exclusive breastfeeding. Health facility and community-based exclusive breastfeeding promotion interventions are therefore needed.

Increasing breastfeeding duration may help physician mothers better counsel their patients. To improve the breastfeeding duration of physician mothers, the factors that may influence their breastfeeding duration should be known.

To investigate the breastfeeding behavior and duration among physician mothers and to determine the factors that influence breastfeeding practices.

This was an online prospective cross-sectional self-report survey. A 26-item author-created data-collecting tool inquiring sociodemographic and work characteristics, medical history of delivery, and breastfeeding history was sent to female physicians who had infants between 12 and 60 months of age via an online social group, “Physician Mothers,” with 11,632 members. Participants (N = 615) responded, and descriptive statistics were analyzed.

Participants’ mean duration of exclusive breastfeeding was 4.8 months (SD = 1.9). The total breastfeeding length was a mean 15.8 months (SD = 7.6). The rate of breastfeeding duration for at least 24 months was 17.8% (n = 75). The most common reason for weaning from breastfeeding was workplace-related conditions (23.6%, n = 145). Participants reported that the mean time of resuming night shifts after delivery was 8.6 months (SD = 4.7). The rate of participants who were unable to use their breastfeeding leave rights partially or completely was 43.6% (n = 268).

Although legislation is in place to allow working mothers to breastfeed their infants, these legal rights were not used properly. Physician mothers should be fully supported in using their breastfeeding leave rights, and workplace conditions should be improved to enable physician mothers to breastfeed their infants for extended periods.

Breastfeeding women are at risk of developing mastitis during the lactation period. Staphylococcus aureus has emerged as the community-acquired pathogen responsible for virulence (methicillin resistance and Panton-Valentine leukocidin toxin producing).

The aim was to compare the microorganisms responsible for mastitis and breast abscesses during breastfeeding.

This observational study was conducted with a sample of women (N = 60) admitted to our hospital between 2016 and 2018. Participants affected by mastitis and breast abscess were studied and cared for by a multidisciplinary working group. A diagnostic breast ultrasound identified the pathology.

Twenty-six participants (43.3%) were affected by mastitis and 34 (56.7%) by breast abscess. The most common microorganism identified was Staphylococcus aureus (S. aureus; mastitis, n = 13; abscesses, n = 24). Methicillin resistance was identified in 21 (44.7%) S. aureus strains: 17 (80.9%) cases of abscess and four (19.1%) cases of mastitis. The median number of months of breastfeeding was smaller in the methicillin-resistant S. aureus (MRSA) cases (median = 3, range = 1–20 months) than in the methicillin-sensitive S. aureus (MSSA) cases (median = 6.5, range = 3–21 months). The Panton-Valentine leukocidin toxin gene was detected in 12 (25.5%) cases (MRSA, n = 8, 66.7%; MSSA, n = 4, 33.3%). Hospitalization was required more frequently in MRSA (n = 8, 38%; five Panton-Valentine leukocidin positive) than in MSSA cases (n = 5, 19%; one Panton-Valentine leukocidin positive). Four women out of the eight MRSA cases (50%) that were Panton-Valentine leukocidin positive stopped breastfeeding during mammary pathologies, three (37.5%) participants continued breastfeeding until the follow-up recall, and one case was lost at follow-up.

Clinical severity was probably complicated by the presence of the Panton-Valentine leukocidin toxin, which required hospitalization more frequently.

Since 25 August, 2017 over 693,000 Rohingya have been forced from Myanmar due to mass violence, seeking refuge in neighboring Bangladesh. Nutritional surveys during 2017 revealed worrying levels of malnutrition and poor infant feeding practices, including high numbers of infants not exclusively breastfeeding. Infants under 6 months who are not exclusively breastfed are particularly vulnerable to morbidity and mortality and require specialized feeding support, especially in emergency contexts.

To describe Save the Children International’s experiences supporting wet nursing, relactation, and artificial feeding for non-breastfed infants under 6 months in the Rohingya Response, Bangladesh.

A retrospective analysis was conducted of routine program data and documentation from Save the Children International’s infant and young child feeding in emergencies interventions for the Rohingya Response, Bangladesh, from November 2017 to April 2018. The study population were infants under 6 months identified as not breastfed during the initial assessment (N = 15).

Although wet nursing was attempted with all infants, it was successful with 6 (40%) of the infants. Additionally, 1 (6.7%) infant’s mother was able to successfully relactate. The remaining infants ended up requiring feeding with human milk substitutes.

Gaps exist in operational guidance to support non-breastfed infants with wet nursing and relactation in emergency settings, as well as on how to operationalize safe human milk substitute programming in line with national policies and regulations. There is an urgent need to address this gap to protect the lives of non-breastfed infants in emergencies worldwide.

Researchers and practitioners continue to debate the most appropriate assessment, diagnostic, and treatment practices for ankyloglossia (tongue-tie). Health care workers struggle to provide evidence-based care in the absence of consistent standards.

The aims of this pilot study were to qualitatively (a) evaluate the knowledge of, and attitudes toward tongue-tie and (b) describe how they shaped referral pathways and the establishment of practice patterns of frontline practitioners (pediatric dentists, speech-language pathologists, pediatric chiropractors, and International Board Certified Lactation Consultants).

We recruited clinicians (N = 9) using nonprobability purposive sampling. Participants were interviewed using survey schedules adjusted to reflect their specialty area. Semistructured interviews were transcribed and coded using manual and inductive coding techniques common in grounded theory. Themes were iteratively developed using memoing techniques, in which observations and potential concepts were recorded using the aforementioned codes.

Participants were familiar with a variety of protocols and assessment tools, but did not consistently use them. No formal training about the management of tongue-tie was received through their degree programs. Instead they pursued self-guided study. Interprofessional consensus guided opinions about tongue-tie best practices, and referral pathways reflected these consensuses. International Board Certified Lactation Consultants were viewed as pivotal to the care of infants with tongue-tie while primary care physicians—primarily pediatricians—were omitted from referral pathways.

Lack of formalized training, professional consensus about best practices, and insufficient resources for assessing and treating tongue-tie led participants to incomplete referral pathways and personal interpretations of the data through the lens of anecdotal evidence.

Induced lactation and relactation are the processes that enable breastfeeding in non-gestating mothers.

The aim of this study was to describe and interpret the challenges faced by mothers who undergo induced breastfeeding and relactation for adopted infants, infants born via surrogacy, and infants born to same-sex female partners.

A qualitative study was performed using in-depth interviews conducted with Spanish women (N = 9) who had decided to undergo induced lactation or relactation. The data were collected between October 2014 and May 2017. The length of the study was due to the difficulty in locating and recruiting the sample. Interviews were transcribed and coded with the ATLAS.ti v.7.5.7 software. We performed a deductive thematic analysis, creating categories based on the interview questions, which we developed on the basis of previous literature about induced lactation and relactation.

Participants described the following challenges: the physical hardships of the process; breastfeeding problems; difficulty with accessing information about induced lactation or relactation; and lack of support from health professionals. Breastfeeding periods lasted from 1.5 months to 4 years. Participants reported that breastfeeding increased the closeness between the mother and child and that this feeling of closeness tended to decrease after breastfeeding cessation.

We offer data and analysis that can improve our understanding of the lived experiences of women undergoing the process of relactation or induced lactation and may help guide intervention strategies to support women in this situation.