Maternal employment and breastfeeding. A study of 567 women's experiences

Factors Related to the Duration of Breast-Feeding in Ankara, with Special Reference to Sociocultural Aspects

A questionnaire designed to elicit information on the relationship between certain sociocultural factors and the duration of breast-feeding was administered to 1,500 mothers. Giving colostrum, demand feeding, night feeding, feeding with both breasts, rooming-in, and planned pregnancy were factors found to have a positive effect on the duration of breast-feeding. Factors having a negative association included the use of prelacteal foods, mothers’ educations, smoking, and maternal employment. For employed mothers, paid maternity leave before and after delivery did not affect the duration of breast-feeding, but unpaid maternity leave and milk leave had a positive effect.

Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study

Background

Breastfeeding is considered to be an important measure to achieve optimum health outcomes for children, women’s return to work has frequently been found to be a main contributor to the early discontinuation of breastfeeding. The aim of the study is to assess workplace breastfeeding support provided to working mothers in Pakistan.

Method

A workplace based cross-sectional survey was conducted from April through December 2014. Employers from a representative sample of 297 workplaces were interviewed on pre-tested and structured questionnaire. The response rate was 93.7 %. Prevalence of workplace breastfeeding facilities were assessed in the light of World Alliance for Breastfeeding Action (WABA) guidelines.

Results

Among non-physical facilities, all workplaces offered 3 months paid maternity leave, 45 % of the sites were offering task adjustment to mothers during lactation period. Only 15 % of the sites were offering breastfeeding breaks to working mothers. Physical facilities that include a breastfeeding corner, refrigerator for storing breast milk, breast milk pump and nursery for childcare were provided in less than 7 % of the sites. Multinational organizations provided better support compared to national organizations.

Conclusion

Support for continuation of breastfeeding by working women at workplaces is inadequate; hence, women discontinue breastfeeding earlier than planned. Policies need to be developed and enforced, employers and employees need to be educated and supportive environment needs to be created to encourage and facilitate breastfeeding friendly worksite environment.

Personal Attitudes or Structural Factors? A Contextual Analysis of Breastfeeding Duration

A personal attitudes model (i.e., infant feeding choices are based on personal attitudes primarily) and a structural factors model (i.e., feeding choices are shaped by the structural contexts of women's lives, as much as personal attitudes) of women's breastfeeding behavior were tested by surveying a longitudinal sample of 548 mostly European American women recruited for the Wisconsin Maternity Leave and Health Project. Personal attitudes (enjoyment of breastfeeding, gender-role attitudes, and work and family salience) accounted for half as much variance in breastfeeding duration for women who were employed outside the home compared to those who were not. For women employed outside the home, both structural variables (length of maternity leave and workplace flexibility) and personal attitudes predicted duration. These results have implications for how we construct the issue of women's breastfeeding decisions.

"Breastfeeding" by feeding expressed mother's milk

This article provides the pediatric community with a practical overview of milk expression and an update on the recent literature. Approaches for working mothers, preterm infants, critically ill infants, and mothers before lactogenesis II are presented separately, as these groups may benefit from practices tailored to individual needs.

Female employees' perceptions of organisational support for breastfeeding at work: findings from an Australian health service workplace

Background

Women's return to work can be a significant barrier to continued breastfeeding. Workplace policies and practices to promote and support continued, and longer duration of, breastfeeding are important. In the context of the introduction of a new breastfeeding policy for Area Health Services in New South Wales, Australia, a baseline survey was conducted to describe current practices and examine women's reports of perceived organisational support on breastfeeding intention and practice.

Methods

A cross sectional survey of female employees of the Sydney South West Area Health Service was conducted in late 2009. A mailed questionnaire was sent to 998 eligible participants who had taken maternity leave over the 20-month period from January 2008 to August 2009. The questionnaire collected items assessing breastfeeding intentions, awareness of workplace policies, and the level of organisational and social support available. For those women who had returned to work, further questions were asked to assess the perceptions and practices of breastfeeding in the work environment, as well as barriers and enabling factors to combining breastfeeding and work.

Results

Returning to work was one of the main reasons women ceased breastfeeding, with 60 percent of women intending to breastfeed when they returned to work, but only 40 percent doing so. Support to combine breastfeeding and work came mainly from family and partners (74% and 83% respectively), with little perceived support from the organisation (13%) and human resources (6%). Most women (92%) had received no information from their managers about their breastfeeding options upon their return to work, and few had access to a room specially designated for breastfeeding (19%). Flexible work options and lactation breaks, as well as access to a private room, were identified as the main factors that facilitate breastfeeding at work.

Conclusions

Enabling women to continue breastfeeding at work has benefits for the infant, employee and organisation. However, this baseline study of health employees revealed that women felt largely unsupported by managers and their organisation to continue breastfeeding at work.

Success of strategies for combining employment and breastfeeding

OBJECTIVE

Return to work is associated with diminished breastfeeding intensity and duration. Although more mothers breastfeed after returning to work now than earlier, research has not documented the strategies that mothers use for combining paid work and breastfeeding or their effect on breastfeeding outcomes. This study examined which strategies are associated with smaller decrements in breastfeeding intensity and longer durations.

PARTICIPANTS AND METHODS

We analyzed 810 mothers from the Infant Feeding Practices Study II who worked and breastfed. We used regression and censored regression models to analyze 4 strategies that mothers used to combine these 2 activities: (1) feed directly from the breast only; (2) both pump and feed directly; (3) pump only; and (4) neither pump nor breastfeed during the work day. Outcomes were the difference in percentage of milk feeds that were breast milk between the month before and after return to work and duration of breastfeeding after return to work.

RESULTS

Forty-three percent of mothers pumped milk at work only; 32% fed the infant directly from the breast only. These 2 strategies, along with pumping and feeding directly, were statistically similar and superior to neither pumping nor breastfeeding during the work day for the outcome of change in breastfeeding intensity. For the outcome of breastfeeding duration, the 2 strategies that included directly feeding from the breast were associated with longer duration than pumping only, whereas the strategy of neither pumping nor breastfeeding during the work day was associated with the shortest duration.

CONCLUSIONS

Feeding the infant from the breast during the work day is the most effective strategy for combining breastfeeding and work. Ways to enable direct feeding include on-site child care, telecommuting, keeping the infant at work, allowing the mother to leave work to go to the infant, and having the infant brought to the work site. Establishing ways for mothers to feed from the breast after return to work is important to meet US breastfeeding goals.

Development of an instrument designed to measure employees' perceptions of workplace breastfeeding support

OBJECTIVE

Breastfeeding rates remain low in the United States, especially among working women. Unfortunately, no quantitative instrument exists to facilitate the examination of why women who return to work discontinue breastfeeding sooner than the general population. The objective of this study was to develop an instrument to measure female employees' perceptions of breastfeeding support in the workplace, which would be suitable for piloting with the target population.

STUDY DESIGN

Examination of the literature, reviews with experts, and one-on-one interviews with women who had experience combining breastfeeding and work were used to create the instrument subscales and items. Examination of the literature was used to develop four subscales: company policies/work culture, manager support, co-worker support, and workflow. Expert review resulted in the addition of a fifth subscale, the physical environment of the breastfeeding space. One-on-one interviews were used to ensure that the item wording was appropriate for the target population.

RESULTS

Eighteen items were added, and 15 were reworded based on comments from the expert review and from the interviews. The resulting survey contained 54 items that required either categorical yes/no or Likert scale responses.

CONCLUSIONS

Results from this process indicate the survey subscales and items adequately reflect women's perceptions of breastfeeding support in the workplace and the instrument is appropriate for piloting with new mother employees.

The effect of employment status on breastfeeding in the United States

BACKGROUND

In the United States, more new mothers are part of the work force than ever before. This trend has implications for many child-rearing practices, including breastfeeding.

METHODS

Based on a national sample of new mothers (n = 228,000), this study considered the prevalence of the initiation and duration of breastfeeding to 6 months after delivery in 2003 among women who were employed full time, who worked part time, or who were not employed outside the home. Breastfeeding trends since 1984 were also considered.

RESULTS

In 2003, at the national level, the prevalence of the initiation of breastfeeding and breastfeeding to 6 months after delivery were 66.0% and 32.8%, respectively. In the hospital, mothers who worked part time had a significantly (p <0.05) higher rate of breastfeeding (68.8%) than those who were employed full time (65.5%), or who were not employed (64.8%). Working full time had a (p <0.05) negative effect on breastfeeding duration. By 6 months after delivery, 26.1% of mothers employed full time, 36.6% of mothers working part time, and 35.0% of nonworking mothers breastfed their infant. Mothers who were not employed were more than twice as likely to breastfeed at 6 months than mothers who worked full time. Breastfeeding trends since 1984 indicated a large increase in the rate of breastfeeding at 6 months after delivery among full-time working mothers (204.5%). However, rates for these women have not yet reached those of mothers who worked part time or were not employed.

CONCLUSIONS

To ensure that the Healthy People 2010 goals for breastfeeding are achieved (75% in the hospital and 50% at 6 months), programs designed to support working mothers who choose to breastfeed must be continued and strengthened.

Socioeconomic status and breastfeeding initiation among California mothers

Objectives. To examine multiple dimensions of socioeconomic status and breastfeeding among a large, random sample of ethnically diverse women.

METHODS

This study used logistic regression analysis to examine the influence of a range of socioeconomic factors on the chances of ever breastfeeding among a stratified random sample of 10,519 women delivering live births in California for 1999 through 2001. Measures of socioeconomic status included family income as a percentage of the federal poverty level, maternal education, paternal education, maternal occupation, and paternal occupation.

RESULTS

Consistent with previous research, there was a marked socioeconomic gradient in breastfeeding. Women with higher family incomes, those who had or whose partners had higher education levels, and women who had or whose partners had professional or executive occupations were more likely than their counterparts to breastfeed. After adjustment for many potential confounders, maternal and paternal education remained positively associated with breastfeeding, while income and occupation were no longer significant. Compared with other racial or ethnic groups, foreign-born Latina women were the most likely to breastfeed.

CONCLUSIONS

The significant association of maternal and paternal education with breastfeeding, even after adjustment for income, occupation, and many other factors, suggests that social policies affecting educational attainment may be important factors in breastfeeding. Breastfeeding rates may be influenced by health education specifically or by more general levels of schooling among mothers and their partners. The continuing importance of racial/ethnic differences after adjustment for socioeconomic factors could reflect unmeasured socioeconomic effects, cultural differences, and/or policies in Latin American countries.

Dietary recommendations for children and adolescents: a guide for practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Dietary Recommendations for Children and Adolescents

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children’s cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Protecting, promoting, and supporting breastfeeding among women in the labor force

The need to protect, promote, and support breastfeeding among women in the labor force is an important global issue that requires greater attention. An increasing proportion of women of child-bearing age are employed outside the home. Women who resume full-time work outside the home when their infants are young tend to have shorter durations of breastfeeding and less exclusive breastfeeding. However, evidence indicates that appropriate breastfeeding policy and support programs can help sustain breastfeeding among employed women. Effective strategies include delayed return to work, working part-time, improved conditions at work for breastfeeding, breastfeeding breaks during work hours, milk expression and storage, and access to breastfeeding counseling. In this chapter, we consider the special needs of women working outside the home; provide a brief overview of the literature; and address international policy regarding the protection, promotion, and support of breastfeeding among women who work outside the home.

Breastfeeding practices in Colorado businesses

The Colorado Worksite Infant Feeding Survey was used to examine breastfeeding support policies and practices within Colorado businesses. Only 28.2% of survey respondents reported that their organization provided breastfeeding support services. However, the majority of businesses did offer benefits and services conducive to breastfeeding. There was a low frequency of positive responses related to incentives for increasing the provision of breastfeeding support services. The incentives receiving the highest frequency of positive responses were those related to employer benefits and needs, such as provision of information on successful breastfeeding support programs within similar organizations; provision of information on the benefits of breastfeeding to employers, including cost savings; and availability of tax credits for providing breastfeeding support services. Multiple approaches are indicated for increasing work-site breastfeeding support and for removing barriers to the achievement of Healthy People 2010 breastfeeding objectives for employed mothers.

Breast milk expression in the workplace: a look at frequency and time

The objective of this article is to study a barrier for breastfeeding women working full-time outside the home: breast milk expression in the workplace. Data are from a large corporation that provides employee benefits. Mothers express breast milk about twice a day when infants are 4 months old (x = 2.2 +/- 0.8) and 6 months old (x = 1.9 +/- 0.6), with a significant decline in frequency (P <.05) comparing the 2 age groups. Most mothers spend 1 hour or less expressing breast milk when infants are 3 (82%) or 6 months old (96%), with a significant difference (P <.05) between the 2 age groups. Mothers of younger infants were no more likely to work fewer days per week than were mothers of older infants. Most women can express breast milk for 3- and 6-month-old infants in less than an hour, distributed in about 2 separate portions, in an employment environment supportive of breastfeeding.

Predictors of breastfeeding duration for employees of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

During the past decade there has been increasing breastfeeding support within the Women, Infants, and Children (WIC) program. For this study, it was hypothesized that employees at WIC would initiate and continue to breastfeed significantly longer than the National averages. Female employees, mostly paraprofessionals, from six Los Angeles County WIC agencies participated in the study to determine breastfeeding rates and predictors of breastfeeding success. As expected, 99% of WIC employees initiated breastfeeding and 68.6% continued to breastfeed to one year, significantly exceeding National averages. Four variables accounted for 30% of the variance in duration of breastfeeding: intent to exclusively breastfeed, delayed introduction of infant formula, attendance at breastfeeding support groups and availability of work-site breastpumps. Given that nearly 70% of the study participants reached the American Academy of Pediatrics goal of breastfeeding to 12 months or more, it is clear that full-time employment and breastfeeding can be compatible given appropriate work-site support.

Breastfeeding and employment: an assessment of employer attitudes

Both research and anecdotal reports suggest that maternal employment is associated with failure to initiate breastfeeding and early breastfeeding attrition. The objective of this study was to describe the experience with and attitudes toward breastfeeding of a sample of employers in a small Midwestern city in the United States. Based on an analysis of 85 mail-out questionnaires, we found that less than half of the employers had personal experience with breastfeeding. A large percentage of the sample, however, indicated that they would be willing to facilitate women who wished to breastfeed or express milk in the workplace. However, these employers also stated that they saw little value to their business of supporting breastfeeding in the work environment. Thus, enhancement of breastfeeding opportunity in the work environment may come as a result of public and employer education but, more likely, will require some type of directive from official sources.

A description of a male-focused breastfeeding promotion corporate lactation program

The role of the father has been identified as one of the strongest influences on the initiation and duration of breastfeeding by mothers in the United States. This report describes a corporate lactation program that focuses on promoting breastfeeding through male employees. Since 1990, a full-time on-site lactation program has been offered to male employees at the Los Angeles Department of Water and Power, a public utility company. The male program participants are from diverse backgrounds. Participation in the Fathering Program has grown since 1990 based on word of mouth, fathers' interest in the benefits of breastfeeding for the infant, and the female partners' interest in getting a free pump rental. This report illustrates the viability of a breastfeeding support program that targets male employees and that is offered in a corporate setting.

Breastfeeding in the workplace

More than 50% of women of reproductive age are employed, and most return to work post partum at a time when exclusive breastfeeding is the ideal. Public health efforts target a goal of increased breastfeeding initiation and duration rates. To be successful at integrating the roles of breastfeeding mother and employee, women need practical advice, the encouragement and support of health care providers, and societal and workplace support. This article discusses the current state of employed breastfeeding women and provides practical guidelines for assisting women to be successful at meeting breastfeeding goals.

Breastfeeding duration of Thai women

This quantitative study aimed to determine Thai working women's planned intention to breastfeed and to identify why the mothers chose to breastfeed their infants, how long they initially planned to breastfeed and how long they actually breastfeed. Ninety-nine Thai working mothers who had breastfed within the last 18 months, or who were still breastfeeding their infants and who used the services at three clinics in Ubon Ratchathani Province, Northeast Thailand were asked to participate in the study. The study findings show a strong correlation between the women's planned duration of breastfeeding and between the length of time she actually breastfed. The authors recommend that breastfeeding educational programs include partners and that the work environment provides support facilities to encourage and support the continuation of breastfeeding.

Factors related to successful breast feeding by first-time mothers when the child is 3 months old

The aim of the reported study was to gain information on those factors which contribute to the success of breast feeding in first-time mothers when the child is 3 months old. The study is part of a wider longitudinal project which follows-up the growth to motherhood of first-time mothers in Finland over a period of 8 months postpartum. Data collection was by questionnaires distributed between March and September 1995. The sample comprised 271 first-time mothers. The mothers completed the questionnaires when their infants were 3 months old. The analysis applied was a polychotomic logistic regression analysis. When the child was 3 months old those mothers who perceived themselves competent as mothers and who felt that society appreciated motherhood appropriately coped better with breast feeding. Also, those mothers who had worked at home prior to the birth of the child and who felt that breast feeding was important in motherhood coped better with breast feeding. Those mothers whose state of mind was more balanced after the birth coped better with breast feeding. The more affirmation the mother received from members of her social network the better she coped with breast feeding. The research findings suggest that factors influencing successful breast feeding in first-time mothers at 3 months postpartum are the mother's own resources and attitude to breast feeding, support from the social network and the current appreciation of breast feeding in society.

Workplace lactation support, Part II: Working with the workplace

Several factors, including new breastfeeding recommendations by the American Academy of Pediatrics, increasing numbers of women with young children in the workforce, more women initiating breastfeeding, and a strong economy combine to make this an ideal time to promote breastfeeding in the workplace. In a previous article, we presented a return-to-work breastfeeding assessment tool to evaluate lactation support in workplaces. This article focuses on the workplace itself, presenting a continuum of types of workplace lactation support; the key players in the workplace, new mothers, supervisors, and human resource managers, who are instrumental in supporting breastfeeding at work; workplace philosophies and their impact on workplace lactation support and strategies to help lactation consultants work with companies as their clients in establishing lactation support programs.

What influences the uptake and early cessation of breast feeding?

OBJECTIVE

To examine obstetric, maternal and social factors associated with the uptake and early cessation of breast feeding and women's reasons for altering from breast to bottle feeding.

DESIGN

Women who responded to a postal questionnaire on long-term postpartum health were contacted and asked to participate in a home-based interview. In addition to health problems, the interview obtained information on baby feeding and a number of social factors. Women were also asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and maternal data were obtained from maternity records.

SETTING

Deliveries from a large maternity hospital in Birmingham.

PARTICIPANTS

906 women were interviewed at a mean of 45 weeks after delivery.

FINDINGS

63% of the women said they had breast fed, but 40% of these stopped within three months of delivery. Many of the women gave physical problems with lactation as reasons for stopping. The factors found to be predictors of early cessation were: return to work within three months of birth; regular childcare support from other female relatives, and a high EPDS score. Non-initiation of breast feeding was predicted by a different set of factors: multiparity; general anaesthetic (GA); and unmarried status.

DISCUSSION AND CONCLUSION

Despite evidence of the benefits of breast feeding, this remains an unacceptable long-term option for many women, and for over one-third it is never attempted. Factors within the woman's social environment were found to influence early cessation. Women who had a GA during or immediately following labour and delivery were less likely to initiate breast feeding.

IMPLICATIONS FOR PRACTICE

If breast-feeding incidence and duration are to increase, more attention should be paid to establishing early, successful breast feeding and countering the negative influences of factors within the social environment.

The effect of work status on initiation and duration of breast-feeding

OBJECTIVES

In this study, longitudinal data are used to examine the effect of work status on breast-feeding initiation and duration.

METHODS

Mothers from a mail panel completed questionnaires during late pregnancy and 10 times in the infant's first year. Mother's work status was categorized for initiation by hours she expected, before delivery, to work and for duration by hours she worked at month 3. Covariates were demographics; parity; medical, delivery, and hospital experiences; social support; embarrassment; and health promotion.

RESULTS

Expecting to work part-time neither decreased nor increased the probability of breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and .89, P > .50), but expecting to work full-time decreased the probability of breast-feeding (OR = .47, P < .01). Working full-time at 3 months postpartum decreased breast-feeding duration by an average of 8.6 weeks (P < .001) relative to not working, but part-time work of 4 or fewer hours per day did not affect duration, and part-time work of more than 4 hours per day decreased duration less than full-time work.

CONCLUSION

Part-time work is an effective strategy to help mothers combine breast-feeding and employment.

Lactation and the labor market: breastfeeding, labor market changes, and public policy in the United States

Public health authorities in the United States actively promote breast-feeding, with target goals for increased beast-feeding rates by the year 2000. In recent decades, however, there has been an increase in the number of American mothers with infants who are in the labor market. Drawing together research examining the intersection of breast-feeding and women's involvement in paid employment, as well as various labor market analyses, this study explores how national recommendations advocating increased breast-feeding among new mothers in paid work are reconciled with economic pressures to return to the labor force in the early postpartum period. This analysis highlights those employment-related factors that constrain the practice of breast-feeding, thereby impeding "choice" over infant feeding method for many mothers. Finally, there is an attempt to explore various employer and public policies and strategies potentially supportive of breast-feeding among mothers in paid employment.

Effects of parity and weaning practices on breastfeeding duration

The purpose of this project was to examine (a) patterns of breastfeeding and (b) duration with parity and breastfeeding experience, and (c) mothers' reasons for termination of breastfeeding. A convenience sample of 120 breastfeeding mothers was followed by home visits and telephone for 20 weeks after delivery. The sample consisted of 69 primiparas, 40 multiparas with previous breastfeeding experience, and 11 multiparas with no prior breastfeeding experience. Parity was not significantly associated with the continuation of breastfeeding but there was a trend toward a difference made by breastfeeding experience. Inadequate milk supply and employment were the two most common reasons reported for weaning. Implications for support in the workplace and for first-time breastfeeding mothers are discussed.

Breastfeeding incidence after early discharge and factors influencing breastfeeding cessation

OBJECTIVE

To determine if the incidence of breastfeeding at 6 to 8 weeks postpartum differs for a mother who had a (usual) 48-hour length of hospital stay versus a mother with a (shortened) 24-hour length of stay and what factors influenced the change from breastfeeding to bottle feeding.

DESIGN

A descriptive two-group survey.

PARTICIPANTS

A convenience sample of 101 primiparous breastfeeding women who had vaginal deliveries of healthy newborns and were between 6 and 8 weeks postpartum.

OUTCOME MEASURE

The incidence of breast and bottle feeding at 6 to 8 weeks postpartum and what perceived factors influenced the decision to change to bottle feeding.

CONCLUSIONS

No difference was found in the incidence of breastfeeding at 6 to 8 weeks postpartum for mothers who had a 48-hour length of stay versus mothers who had a 24-hour length of stay with a home visit. Additional studies of the factors influencing change from breast to bottle feeding should be conducted.

Breast-feeding in the workplace: how to succeed

As the numbers of women of childbearing age in the workforce continue to increase, some employers and employees have viewed maternal employment to be incompatible with breast-feeding. This qualitative study investigated factors that hindered as well as facilitated breast-feeding in the workplace. Findings suggest breast-feeding and employment can and should be compatible.

Breastfeeding promotion for the employed mother

Increasing numbers of mothers are returning to work during the first year of their infant's life. Maternal employment has been associated with decreased duration of breastfeeding. Breast milk remains the optimal source of infant nutrition, yet only 50% of families choose breastfeeding for their newborns. Clinicians in pediatrics are well positioned to promote the specific benefits to mother and baby that breastfeeding provides through advocacy, education, and support with regard to breastfeeding and employment. Anticipatory guidance specifics such as feeding patterns, guidelines for pumping and storing breast milk, and information regarding available resources are clinical knowledge areas that pediatric health care providers must have to increase breastfeeding rates and duration among women who return to the work force after the birth of their baby.

Predicting the duration of lactation: evidence from a national survey

BACKGROUND

Despite caregiver and policy support for breastfeeding, rates for initiating and duration of breastfeeding fell far short of Healthy People 2000 goals during the 1980s.

METHODS

Data from the 1988 National Maternal-Infant Health Survey, collected from January 1989 through June 1991, were analyzed to examine predictors of duration of lactation for a sample of 2372 breastfeeding women. We conducted comparisons between women who fully breastfed and those who partially breastfed using logistic regression analysis.

RESULTS

Mothers were more likely to breastfeed for longer than six months if they fully breastfed during the first month postpartum, were nonsmokers, were of higher parity, were consistent in their prenatal intent to breastfeed fully or partially and in their postpartum behaviors, participated in childbirth education classes, and delayed their return to work postpartum.

CONCLUSIONS

In this study sample, although rates did not meet Healthy People 2000 goals for duration of breastfeeding, some predictors of duration were identified that can be affected by programmatic support or public policy. Our findings indicated that variables that are associated with breastfeeding and longer duration of the practice are typically correlated with social status. To support the development of breastfeeding as the cultural norm, interventions targeting breastfeeding outcomes should consider social status, ethnicity, and cultural factors.

Trends in the relationship between breastfeeding and postpartum employment in the United States

It is widely assumed that employment and breastfeeding are relatively incompatible behaviors in the United States; yet recently both the incidence of breastfeeding and the incidence of postpartum employment increased. This paper examines the relationship between these trends from 1968-86 using data from the National Surveys of Family Growth. I find that these trends result from increases in the likelihood that a woman engages in both breastfeeding and postpartum employment. There has been an increase over time in the incidence and duration of women concurrently breastfeeding and working. However, the majority of employed women did not concurrently breastfeed, suggesting that conflicts between these behaviors still exist.

Working women, maternity entitlements, and breastfeeding: a report from Bangladesh

Early infant feeding practices and facilities available for supporting breastfeeding in workplaces in Dhaka, Bangladesh were studied through interviews with working women (n = 238) with children younger than 30 months of age. Of the women interviewed, 20 percent were aware of the benefits of, and had exclusively breastfed in the first month, 13 percent in the second month, and two percent in the fifth month of employment. The median age of starting complementary feeds was 41 days (range, 1-210) preparatory to resuming work. Total duration of breastfeeding was significantly shorter in mothers who had started these feeds before 41 days of age as compared to those who started later (mean +/- SD) 275 +/- 216 days versus 361 +/- 223 days (p = 0.003). Ninety-nine percent of the mothers were unaware of their maternity entitlements, and only 20 percent had taken breaks for breastfeeding, those breaks being treated as "unofficial." Working women should be informed through health personnel and communication media, about the benefits of exclusive breastfeeding and about maternity entitlements. Provision of facilities to support breastfeeding in the workplace must also be encouraged so that maternal employment does not hamper breastfeeding.

Impact of attitudes on maternal decisions regarding infant feeding

It is essential that physicians and other health care professionals seeking to increase the rate of initiation and duration of breast-feeding build on the body of information concerning factors that influence a woman's attitudes about breast-feeding. The relation between positive attitudes concerning breast-feeding and its initiation is important to the development of programs targeting women before they become pregnant, and to the provision of active support for breast-feeding throughout the pregnancy, perinatal, and postnatal period. However, it is not sufficient for these programs to target only the mother or potential mother; members of a woman's social network must be considered as information targets. Educational programs must also be directed to the appropriate racial or ethnic group to develop programs that reach the individuals (father, female relative, or friend) most likely to influence the mother's breast-feeding decision. Physicians may be very knowledgeable about the nutritional and immune properties of human milk and yet not be supportive of the act of breast-feeding. This lack of support may be manifested by the lack of verbal support for women who intend to or are in the process of breast-feeding, the provision of infant formula before or at the time of birth of the baby, or encouragement to terminate breast-feeding should the mother encounter any difficulties with lactation. To increase physician awareness of the process of breast-feeding and the properties of human milk, information about the benefits should be integrated in both the basic science and the clinical curricula of medical schools. Primary care training programs, including obstetrics, should actively involve trainees in the management of breast-feeding women so that trainees become aware of the spectrum of circumstances that confront women seeking to establish and maintain successful breast-feeding. This type of involvement would provide a contextual base for physicians' understanding the attitudes and behaviors supportive of breast-feeding. Attitudes and behavior of women, although more complex then demographic factors, provide a powerful tool for meeting the Healthy People 2000 goals for the initiation and duration of breast-feeding. It is important to build on the base of research reviewed here to develop new and and more powerful interventions. Thus the emphasis on the known health advantages of human milk or the discovery of additional health benefits of breast-feeding should continue to be discussed because they may tip the balance in favor of breast-feeding for some women. Nevertheless, it may ultimately be more important to increase the amount of information provided to women (and girls and boys) about the practical aspects of the breast feeding process (e.g., ease of night feeding, fathers ability to feed mother's milk by bottle, lower cost, strategies to control leaking) then to rely solely on the positive health outcomes related to breast-feeding.

The impact of two corporate lactation programs on the incidence and duration of breast-feeding by employed mothers

PURPOSE

The goal of this study was to examine the impact of two corporate lactation programs on breast-feeding behavior among employed women.

DESIGN

Breast-feeding behavior was measured for up to one year among women who had given birth during 1989, 1990, 1991, and 1992 and compared with national norms.

SETTING

The study was conducted at two corporations: a utilities company with 11,000 employees of which 22% were female with approximately 100 births each year and a space corporation with 3,900 employees of which 31% were female with approximately 30 births per year.

SUBJECTS

Participants were 187 employees returning to work following maternity leave for a medically uncomplicated birth.

INTERVENTION

Participants collected and stored breast milk using the worksite breast pump room at scheduled times during the workshift and were counseled by a lactation professional throughout the study.

MEASURES

A questionnaire was used to establish breast-feeding behavior. Duration was reported by the lactation professional.

RESULTS

Since program inception, 75% of the participants who returned to work while breast-feeding continued until their child was six months old. This represented 139 of the 187 mothers at the two companies. Average duration of breast-feeding overall was 8.1 months.

DISCUSSION

Participants were able to maintain a breast-feeding regimen for at least six months at rates equivalent to the statistical norms for women who are not employed outside the home. This was not an experimental study. Participants were self-selected and there was no control group. On a year-to-year basis, the numbers of participants were relatively small.(ABSTRACT TRUNCATED AT 250 WORDS)

Can magnesium sulfate therapy impact lactogenesis?

This case report describes a patient who ingested magnesium sulfate (MgSO4) for approximately four days as a treatment for pregnancy-induced hypertension. Stage II lactogenesis was delayed until the tenth postpartum day at which point the patient's breasts became fully engorged. No explanation for this delay was found, other than the possibility that magnesium sulfate treatment impeded lactogenesis. Implications for professionals who care for lactating women are discussed.

The relationship of attitudes, knowledge, and social support to breast-feeding

Although more women are initiating breast-feeding, few continue for more than 1-3 months into the postpartum period. The current report studied the relationship of attitudes, social support, experimental and demographic variables, and knowledge to length of breast-feeding. A totaL of 102 women were included in the study and were followed for 1 year. Perceived attitudes toward breast-feeding, selected demographic variables, and past experiences were related to length of breast-feeding.

Breastfeeding and employment

Breastfeeding problems, outcomes, and satisfaction of married, well-educated first-time mothers who returned to work within six months postpartum were compared to those of mothers with the same characteristics who stayed at home. Mothers who planned to work after giving birth anticipated and experienced shorter durations of breastfeeding than did those who planned to remain at home. Breastfeeding experiences and satisfaction among working mothers differed little from the experiences and satisfaction of their nonworking counterparts; however, employment prior to two months postpartum exerted some negative effects on breastfeeding outcomes.

Anticipatory guidance for the employed breast-feeding mother

A significant number of women are combining childrearing and career. Mothers who opt to breast-feed while employed may demonstrate increased breast-feeding success when supported by knowledgeable counseling. This article discusses specific techniques for maintaining maternal fluid intake; pumping, storing and preparing breast milk; wardrobe planning; and personal hygiene. Knowledge of these measures will provide the basis for anticipatory guidance for mothers who wish to balance the demands of breast-feeding and employment.

Breastfeeding fallacies: their relationship to understanding lactation

When inaccurate information is the basis for clinical decision making, patient care is likely to be incomplete, inappropriate, and potentially harmful. We identified 17 fallacies relating to lactation and breastfeeding that exist in the professional and lay literature and that continue to be perpetuated among care providers and shared with new mothers. The inappropriateness and inaccuracy of these beliefs, and how they influence attitudes about, and practices relating to, breastfeeding, are discussed. Alternatives to these fallacies exist, and their use may contribute to more relevant care and advice giving, and to successful breastfeeding.

Sequential and simultaneous breast pumping: a comparison

This study compared sequential single-breast pumping with simultaneous double-breast pumping using an interrupted time series design to determine if (a) milk volume differed by pumping regimen; (b) the time needed to pump the breasts differed by pumping regimen; and (c) the milk fat concentrations differed by pumping regimen. In both limited and unlimited pumping sessions, the simultaneous double pumping option obtained higher mean milk volumes, reaching statistical significance in three of the four comparisons. Differences in milk fat concentrations were not statistically significant, when simultaneous breast pumping occurred, as compared with sequential pumping. Mothers' preferences regarding pumping regimen influenced mean milk volumes obtained in the direction of the women's preferences.

Infant feeding patterns during the first year of life in Denmark: factors associated with the discontinuation of breast-feeding

We prospectively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, over the first 12 months of life using a detailed monthly mailed questionnaire (overall response rate = 73%) which focused on feeding practices and illnesses. Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19% at 12 months of life. Analysis of breast-feeding behavior using survival analysis showed that 50% of the mothers who breast-fed since the first month of their infant's life were still breast-feeding at 7 months of life. Also, there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare (RR = 2.08, 95% CI = 1.43, 3.01). Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class. These results give insight into infant feeding patterns in a developed country and suggest that: (1) breast-feeding is the dominant method of feeding during the infant's first year of life, and (2) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare.

Intending to breastfeed and work

Many women who return to the work force during the first year following the births of their infants plan to combine breastfeeding and work; yet little is known about the process of preparing for the transition from breastfeeding in the home to continuing to breastfeed while employed. A study was conducted to explore mothers' decision-making processes during this transition. Interviews were conducted with 61 urban Canadian mothers who intended to continue breastfeeding after returning to work. Participants revealed that, although they intended to continue breastfeeding, whether or not they actually did depended on many factors that were beyond their control. These mothers had to play it by ear. They made elaborate plans, as well as back-up plans, allowing for all possible eventualities.

Does maternal employment affect breast-feeding?

A prospective survey of maternal employment and breast-feeding initiation and duration was conducted among 668 Black and 511 White women who delivered their first child in Washington, DC. Ninety-one percent of White women (n = 511) and 80 percent of Black women (n = 668) reported working during pregnancy. Black women who planned to return to work part time vs full time were more likely to breast-feed rather than formula-feed (adjusted odds ratio, 2.3; 95% confidence intervals (CI) = 1.4, 3.7). Using Cox regression, Black women who returned to work had a shorter duration of breast-feeding than those not returning to work (hazard ratio = 0.5 (CI = 0.3, 0.9]. Black and White women returning to professional occupations had a longer duration of breast-feeding compared to women returning to sales or technical positions (hazard ratio for Black women = 2.4 (CI = 1.4, 44); hazard ratio for White women = 1.6 (CI = 1.0, 2.5]. In addition, White women in professional occupations had a longer duration of breast-feeding than women in clerical positions (hazard ratio = 1.7 (CI = 1.1, 2.6]. Until employers in the United States develop a maternity policy which does not discourage breast-feeding, the recommended six months of breast-feeding will be difficult to achieve for most employed women.

Management of selected early breastfeeding problems seen in clinical practice

Management guidelines for six common clusters of breastfeeding situations or problems commonly seen in clinical practice are discussed. These include inadequate infant weight gain, insufficient milk supply, nipple problems, latch-on and sucking disorganization, high-risk situations, and the "good baby" syndrome. Charts are provided describing devices and specialized techniques from which to choose when creating a feeding plan.

Medical management of successful breast-feeding

Despite the present climate of professional and lay enthusiasm for breast-feeding, many women experience problems in the initiation of lactation, either because of misinformation, secondary lactation difficulties, or primary failure of lactation. This article provides pediatricians with practical guidelines for the successful initiation of breast-feeding and the prevention and early detection of problems. Recommendations are made for optimal prenatal preparation for breast-feeding, intrapartum routines that facilitate lactation, appropriate early follow-up of nursing infants, and the management of the full normal course of breast-feeding.