Association of child care providers breastfeeding support with breastfeeding duration at 6 months

Type of Child Care Setting Is Associated With Child Care Constraints and Food Insecurity Among Families With Low-Incomes

OBJECTIVE

High quality child care positively affects long-term development in children and is a necessary support for parents who work or are in school. We assessed the association between child care setting and parents' report of difficulties with ability to work and/or further their education ("child care constraints") or material hardships among families with low incomes.

METHODS

Cross-sectional data were analyzed from families in Minneapolis, MN with children aged six weeks to 48 months in child care from 2004 to 2017. Associations between child care setting (formal, informal relative, informal non-relative) and child care constraints or material hardships (household/child food insecurity, housing instability, energy instability) were examined.

RESULTS

Among 1580 families, 73.8% used informal care. Child care subsidy and public assistance program participation were higher among families utilizing formal care. Compared to formal care, families using informal relative or non-relative care had 2.44 and 4.18 greater adjusted odds of child care constraints, respectively. Families with children in informal non-relative care had 1.51 greater adjusted odds of household food insecurity. There were no statistically significant associations between informal relative care and household or child food insecurity, and no associations between child care setting and housing instability or energy insecurity.

CONCLUSIONS

Informal care settings-relative and non-relative-were associated with child care constraints, and informal non-relative care with household food insecurity. Investment to expand equitable access to affordable, high-quality child care is necessary to enable parents to pursue desired employment and education and reduce food insecurity.

Father support for breastfeeding mothers who plan to utilize childcare: A qualitative look at Mothers' perspectives

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.

Returning to Work and Breastfeeding Duration at 12 Months, WIC Infant and Toddler Feeding Practices Study-2

Background: Returning to work can impact breastfeeding duration; limited data exist on how this may impact a lower income population. Methods: Data from U.S. Department of Agriculture's longitudinal study WIC Infant and Toddler Feeding Practices Study-2 were used to assess breastfeeding duration (<12 versus ≥12 months) by age of the baby when women first returned to work and work status (full time and part time). Multivariable logistic regression was used to determine the association of the timing of return to work, work status, and the combination (timing and work status) with breastfeeding duration. Results: Among women who had worked prenatally and initiated breastfeeding, 20.2% breastfed for ≥12 months. Compared to women who did not return to work, fewer women breastfed for ≥12 months if they returned full time or part time (34.1%, 12.0%, and 20.0%, respectively, p < 0.0001). Work status negatively impacted breastfeeding for ≥12 months (full-time adjusted odds ratio [aOR]: 0.24; 95% confidence interval [CI]: 0.13, 0.44 and part-time aOR: 0.51; 95% CI: 0.31, 0.83). Compared to women who did not return, those who returned full time within 3 months or returned part time >1 to 3 months after birth had lower odds of breastfeeding ≥12 months. Conclusions: Returning to work within 3 months after birth had a negative impact on breastfeeding for ≥12 months, particularly for those who returned full time. Efforts to support maternity leave and flexible work schedules could prolong breastfeeding durations among a low-income population. This study was a registered study at clinicaltrials.gov (NCT02031978).

Factors Related to Breastfeeding Support in Lebanese Daycare Centers: A Qualitative Study among Daycare Directors and Employees

Breastfeeding has an important impact on maternal and child health, and is affected by several factors influencing its initiation and continuation. This qualitative study aimed to assess the main promoting and hindering factors for breastfeeding support in Lebanese daycare centers (DCCs), through the perspective of their directors and employees. The study was based on semi-structured interviews with 13 directors and 9 employees. It explored the influence of various cognitive factors as well as different environment types (physical, economic, political, and sociocultural) on their breastfeeding support. Findings suggested the directors and employees valued improving breastfeeding support in DCCs and the physical set-up of the DCCs allowed for this. However, various other factors restricted their abilities to support breastfeeding in the DCC, including limited knowledge and training on the topic, absence of written internal policies on breastfeeding, lack of enforcement in the application of national policies, and the current mothers’ work policies that negatively influenced the decision to breastfeed. Improvements could be achieved through integrated interventions, targeting the interaction of internal DCCs factors and national and DCCs breastfeeding policies, as well as several social factors, to create a multilevel approach targeting breastfeeding continuation support in breastfeeding-friendly DCCs in Lebanon and the region.

Australian Foster Carers' Views and Concerns Regarding Maternal Drug Use and the Safety of Breastmilk

Parental substance misuse and mental health issues are major factors associated with infant placement into out-of-home care. Such placements may result in disruption and/or cessation of breastfeeding. Provision of breastmilk to infants in out-of-home care (OOHC) is desirable in terms of infant health and development, and also in supporting maternal caregiving. However, little is known about how breastfeeding is supported for infants in out-of-home care. This study used an online survey to explore the facilitation of breastfeeding in the context of OOHC and foster carers' management of expressed breastmilk (EBM). Foster carers were generally open to the idea of maternal breastfeeding and infants in their care receiving EBM from their mothers. However, the majority of respondents expressed concern regarding the safety of EBM for infant consumption due to the possibility of harmful substances in the milk. Concerns regarding the safety of handling EBM were also prevalent. These concerns caused foster carers to discard EBM. Findings suggest foster carers' may lack knowledge related to maternal substance use and breastmilk. Better integration between health care and social service systems, where the voices of mothers, foster carers and child protection workers are heard, is necessary to develop solutions enabling infants living in OOHC access to their mother's breastmilk.

Nutrition Provided to Infants in Licensed Childcare Centers and Homes: A Descriptive Study

BACKGROUND

Infant nutrition can influence development, eating behaviors and obesity risk. Nearly half of infants in the U.S. are in non-parental care where they consume much of their daily nutrition. Because little is known about the quality of infant nutrition in childcare, the study objective was to characterize the foods and beverages provided to infants in childcare in California.

METHODS

From a randomly selected sample of 2,400 licensed childcare in California, 736 responded to a 2016 survey; a subset of 297 cared for infants. Differences in 26 foods and 7 beverages provided between centers and homes, and by CACFP participation, were assessed using logistic regression models adjusted for CACFP participation and whether the site was a center or home, respectively.

RESULTS

Several differences between centers and homes were identified. One the day prior to the survey, more centers than homes ever provided cow's milk (25.1% vs 13.0%, p = 0.02) and whole grains (76.7% vs 62.9%, p = 0.03), and fewer centers than homes provided frozen treats (1.4% vs 10.3%, p = 0.003). When comparing difference by CACFP participation, fewer CACFP than non-CACFP sites usually provided breastmilk (32.6% vs 54.2%, p = 0.0004) and ever provided cow's milk (14.2% vs 37.1%, p < 0.0001). On the day prior to the survey, more CACFP than non-CACFP provided vegetables (91.0% vs 80.8%, p = 0.02), fruit (centers only) (97.2% vs 80.8%, p = 0.0003), and infant cereals (86.0% vs 61.2%, p < 0.0001). Fewer CACFP than non-CACFP provided sweetened yogurt (14.8% vs 36.7%, p < 0.0001).

CONCLUSIONS FOR PRACTICE

Childcare centers and CACFP participants tended to serve nutritious foods more than childcare homes and non-CACFP participants, respectively. Additional education and policies for childcare providers on appropriate foods and beverages for infants is recommended.

Improving Breastfeeding Environments and Feeding Practices in Family Child Care Homes with the Go NAP SACC Program

PURPOSE

Breastfeeding and responsive feeding are important practices that support the health of infants and women. In the United States, breastfeeding continuation rates remain lower than recommended, and working women face additional challenges with breastfeeding continuation. Providers in a family child care setting are uniquely positioned to support and provide important resources to families in their breastfeeding and infant feeding practices.

METHODS

The Go NAP SACC program was designed to improve the nutrition and physical activity environments and practices in child care settings serving infants and young children. This evaluation focuses on Breastfeeding and Infant Feeding in Nebraska Family Child Care Homes (FCCH).

ASSESSMENT

Paired-sample t-tests were used to examine differences in pre-post evaluation scores. A repeated measure ANCOVA was used to examine differences between rural-urban settings. Nebraska FCCH met recommendations at pre-test, and exceeded recommendations at post-test (p < .05). Rural and urban FCCH performed equally well in 18 of 22 items, indicating little difference in the ability to provide supportive environments and adhere to best practices in both settings. Improvement in family engagement items were significant at the p < .001 level. Family engagement in FCCH is an important area for intervention that was well-received by provider participants.

CONCLUSION

This evaluation shows that the Go NAP SACC program improves breastfeeding and infant feeding environments and practices in rural and urban FCCH. Interventions should continue to focus on basic and practical education and professional development for FCCH providers, with emphasis on intentional family engagement and support.

"Breast Is Best, But…" According to Childcare Administrators, Not Best for the Childcare Environment

Background: Nearly 74% of U.S. mothers work full-time and employment is a cited reason for stopping breastfeeding. In the effort to increase breastfeeding duration, childcare providers could facilitate continuation of human milk feeding when mothers return to work. Yet, mothers report receiving little support when transitioning infants into childcare. Objective: Explore the themes of comfort with human milk and formula feeding among childcare administrators near Tampa, Florida. Material and Methods: Twenty-eight childcare administrators participated in semistructured interviews regarding policies and perceptions about infant feeding practices at their center. Using Applied Thematic Analysis, interview themes were identified. Results: Most administrators agreed "breastfeeding is best." However, they expressed discomfort with mothers breastfeeding at the center and perceived risk with handling and feeding human milk. These perceptions are illustrated through the theme "Formula feeding is normative" and four emergent subthemes: "Human milk is potentially harmful," "People are uncomfortable with breastfeeding in public," "I'm not the expert," and "'Breastfeeding is best', in theory." Conclusion: While breastfeeding may be best for health, from the childcare administrators' perspectives, it may not be best for the childcare environment. A cultural shift may be needed to change norms and perceptions in the childcare environment to support mothers in their effort to provide human milk. Perhaps it is time for a new message, such as "We can help you."

Integrative Review of Breastfeeding Support and Related Practices in Child Care Centers

OBJECTIVE

To synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally.

DATA SOURCES

We used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies.

STUDY SELECTION

We included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review.

DATA EXTRACTION

We abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings.

DATA SYNTHESIS

We categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages.

CONCLUSION

We found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.

An Exploratory Look at the Role of Childcare Providers as a Support and Resource for Breastfeeding Mothers

Introduction: The childcare setting remains largely unexplored as a potential barrier to breastfeeding continuation and, therefore, the lack of interventions targeting childcare providers may be a missed opportunity for improved breastfeeding support. This article explores the perceptions of 25 first-time breastfeeding mothers on navigating the critical transition to childcare and the role of childcare providers regarding breastfeeding support. Methods: Mothers were selected if they indicated an intent to breastfeed on a prenatal questionnaire and had enrolled their child in childcare. Semistructured interviews guided by Bronfenbrenner's bioecological model were conducted to capture mothers' experiences. Responses were analyzed utilizing thematic analysis to generate themes rooted in mothers' experiences with childcare and breastfeeding. Results: A thematic analysis resulted in three key themes: Providers are not Critically Evaluated, A Stressful Transition, and Childcare as a Service, not Support. These themes indicated that although mothers intended to continue breastfeeding during and after the transition to childcare, they had not previously given much consideration to the childcare setting beyond that of a service provider. Conclusion: Findings illustrate new considerations to support modern breastfeeding mothers through the transition to work and childcare are needed such as basic and practical education and training to prepare childcare providers to support breastfeeding mothers in the way that best meets their needs, enhanced education for mothers on how to seek and evaluate providers for breastfeeding competence, and policy initiatives focused on fostering engagement between mothers and providers. By taking mothers' perceptions into consideration, researchers, practitioners, and policymakers can offer breastfeeding support that mothers will be receptive to and more likely to engage with, thereby advancing the health of both mothers and infants.

A Pilot Study of Mothers' Breastfeeding Experiences in Infants With Cleft Lip and/or Palate

BACKGROUND

Despite the recognized importance of human milk (HM) use, breastfeeding is often discouraged for infants with cleft lip and/or palate because of their anatomical abnormalities. Poor weight gain may require formula for calorie supplementation. Stresses associated with caring for infants with cleft lip/palate may decrease rates of HM provision to these infants.

PURPOSE

This study investigates the experiences of mothers of infants with cleft lip/palate (CL/P) to determine choices and factors associated with providing HM to their infants.

METHODS

A retrospective telephone survey was administered to a cohort of mothers of infants with CL/P.

RESULTS

Fifty mothers agreed to participate in the survey. Most (78%) initiated use of HM for a median duration of 4 months, 32% provided HM for 6 months or more, and 79% exclusively expressed their HM. Poor supply was the most frequent challenge to providing HM and led to cessation in 46% of the mothers. Formula was used to supplement for poor supply or poor infant weight gain in 90% of the mothers. The best predictors of a mother's use of HM were child not in day care, genetic diagnosis, and gestational age at birth. Only 36% of mothers reported individual encouragement to provide HM, and 18% reported they were specifically discouraged from providing HM for their infants.

IMPLICATIONS FOR PRACTICE

Although initiation rates were high, there are opportunities to improve support for mothers to increase duration of HM provision in children with CL/P.

IMPLICATIONS FOR RESEARCH

This study establishes a baseline for future prospective studies looking at the impact of active encouragement and provision of lactation support within the cleft team setting.

'Why do we need a policy?' Administrators' perceptions on breast-feeding-friendly childcare

OBJECTIVE

Mothers' return to work and childcare providers' support for feeding expressed human milk are associated with breast-feeding duration rates in the USA, where most infants are regularly under non-parental care. The objective of the present study was to explore Florida-based childcare centre administrators' awareness and perceptions of the Florida Breastfeeding Friendly Childcare Initiative.

DESIGN

Semi-structured interviews were based on the Consolidated Framework for Implementation Research and analysed using applied thematic analysis.

SETTING

Childcare centre administrators in Tampa Bay, FL, USA, interviewed in 2015.ParticipantsTwenty-eight childcare centre administrators: female (100 %) and Non-Hispanic White (61 %) with mean age of 50 years and 13 years of experience.

RESULTS

Most administrators perceived potential implementation of the Florida Breastfeeding Friendly Childcare Initiative as simple and beneficial. Tension for change and a related construct (perceived consumer need for the initiative) were low, seemingly due to formula-feeding being normative. Perceived financial costs and relative priority varied. Some centres had facilitating structural characteristics, but none had formal breast-feeding policies.

CONCLUSIONS

A cultural shift, facilitated by state and national breast-feeding-friendly childcare policies and regulations, may be important for increasing tension for change and thereby increasing access to breast-feeding-friendly childcare. Similar to efforts surrounding the rapid growth of the Baby Friendly Hospital Initiative, national comprehensive evidence-based policies, regulations, metrics and technical assistance are needed to strengthen state-level breast-feeding-friendly childcare initiatives.

Creating Environments to Support Breastfeeding: The Challenges and Facilitators of Policy Development in Hospitals, Clinics, Early Care and Education, and Worksites

Objectives Supportive organizational breastfeeding policies can establish enabling environments for breastfeeding. In this qualitative study we identify facilitators and barriers to the development, adoption, and implementation of supportive breastfeeding policies and practices in four influential sectors for breastfeeding women: hospitals, clinics, early care and education settings, and worksites. Methods We interviewed 125 individuals representing 110 organizations in Washington State about their breastfeeding policy development and implementation process between August 2014 and February 2015. Greenhalgh's diffusion of innovations framework guided the interviews and qualitative analysis. Results Breastfeeding policy facilitators across the sectors include national and state laws and regulations, performance tracking requirements, and an increasingly supportive sociopolitical climate; barriers include limited resources and appreciation about the need for breastfeeding policies, and certain organizational characteristics such as workforce age. Despite broad support for breastfeeding, organizations differed on perceptions about the usefulness of written breastfeeding policies. Personal breastfeeding experiences of policy makers and staff affect organizational breastfeeding policies and practices. Conclusions for Practice Supportive organizational systems and environments are built through effective policy development processes; public health can support breastfeeding policy development and assure a coordinated continuum of care by leveraging federal health care policy requirements, building networks to support training and collaboration, and disseminating strategies that reflect the personal nature of breastfeeding.

Pediatric Care Providers, Family, and Friends as Sources of Breastfeeding Support Beyond Infancy

OBJECTIVE

To examine women's perceptions about support from pediatric primary care providers (PCPs), family, and friends for breastfeeding beyond 12 months, which is an increasing common practice.

STUDY DESIGN

Women who breastfed at least one child beyond 12 months completed an online questionnaire distributed via La Leche League USA (2013). Questionnaire content focused on sources of support for breastfeeding beyond 12 months, support ratings, and participant characteristics. Bivariate statistics and multivariable log-binomial regression compared ratings of support across sources, by PCP sex, and with breastfeeding duration.

RESULTS

Of 48,379 eligible U.S. women, about half discussed their decision to breastfeed beyond infancy with their child's PCP. In contrast, almost all (91.4%) did so with their spouse, partner, or significant other. Women were consistently more comfortable discussing their decision to breastfeed for more than a year with their family and closest friend than they were with their child's PCP (all p < 0.001). Three-fourths of PCPs were rated as supportive, but 11.1% were somewhat or very unsupportive. Female pediatricians received similar ratings as males (adjusted risk ratio = 1.01, 95% confidence interval: 1.00, 1.03). Thirty-eight percent of women who reported their PCP was unsupportive changed PCPs.

CONCLUSION

Family and PCP support is likely to be important for the growing proportion of U.S. mother-child dyads who are breastfeeding beyond 12 months. Many, but not all, women rated their child's PCP as supportive, and lack of support was a reason women reported for changing PCPs. Evidence-based interventions in primary care to support breastfeeding beyond infancy are needed.

Creating Supportive Breastfeeding Policies in Early Childhood Education Programs: A Qualitative Study from a Multi-Site Intervention

Objectives To understand the process by which early childhood education (ECE) providers effectively used an existing intervention to facilitate the creation or strengthening of a written breastfeeding policy, understand the factors important to this process, and present a logic model to guide future intervention design and evaluation. Methods A purposive sample of interviewees who recently completed an ECE nutrition and physical activity intervention and reported positive pre-post scores for breastfeeding support were recruited to complete semi-structured interviews. Interviews were recorded, transcribed, and coded, following a Grounded Theory approach. Results The ECE programs (n = 23) had a written breastfeeding policy and were located across six states in the United States. The most common aspects of breastfeeding support covered in the policies were handling and storing of breastmilk, pieces of equipment to be provided (e.g., breast pump), and the creation of a space or room designated for breastfeeding and pumping. Many factors important to the policy creation process were identified such as motivation, education, technical assistance, perceptions of parental indifference, staff buy-in, and time and administrative constraints. Once motivated to create a policy, ECE providers described actions, such as gathering background information and model policies, discussing policy needs with stakeholders, utilizing technical assistance, and overcoming barriers. Conclusions for Practice From these findings, a logic model was created to guide future intervention design and evaluation, and several recommendations were made to help guide subsequent interventions in promoting the development and implementation of written breastfeeding policies at ECE programs.

Childcare workers' experiences of supporting exclusive breastfeeding in Kuala Muda District, Malaysia: a qualitative study

Background

The role of childcare workers at registered nurseries in supporting exclusive breastfeeding practice is important, as many newborn babies are placed in nurseries during working hours. To increase exclusive breastfeeding rates among working mothers, understanding childcare workers’ experiences and needs relating to supporting these mothers is crucial. This study aimed to explore childcare workers’ experiences of supporting breastfeeding at registered nurseries.

Methods

We used a qualitative design to conduct in-depth, semi-structured interviews with ten childcare workers at seven registered nursery centres in Kuala Muda District, Malaysia. Attitudes towards exclusive breastfeeding practice, experiences of breastfeeding training and information, and experiences supporting exclusive breastfeeding at the nursery were explored. Participants were asked to suggest improvements for exclusive breastfeeding practice at their nursery. All interviews were audio recorded, transcribed verbatim, and translated before analysis.

Results

All participants demonstrated a positive attitude in supporting and promoting exclusive breastfeeding practice, mainly centred on the advantages of breastfeeding. Various supports have been found such as labelling bottled breastmilk, allowing the mother to come to the nursery during breaks, and providing reading materials. However, several issues emerged that include parents’ choice on infant feeding practice, insufficient content on breastfeeding topics during training, and adherence to the (not recommended) practice of bottle feeding expressed breastmilk. Recommendations to enhance breastfeeding were also suggested by participants.

Conclusion

Childcare workers may serve as another potential resource for sustaining exclusive breastfeeding at registered nurseries.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0095-4) contains supplementary material, which is available to authorized users.

Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration?

AIM

To explore the link between breastfeeding duration and bed-sharing frequency among women reporting a prenatal intention to breastfeed.

METHODS

About 870 participants in a randomised breastfeeding trial, recruited at mid-pregnancy, provided weekly snapshots of breastfeeding and bed-sharing behaviour for 26 weeks following birth. Strength of prenatal breastfeeding intent was recorded at recruitment using Likert-type scales.

RESULTS

Outcomes were frequency of bed-sharing at home for at least one hour per week, and time to cessation of breastfeeding. There were insufficient data to classify bed-sharing pattern in 192/870 (22%) of mothers. Of the remainder, 44% (299/678) of participants 'rarely' or 'never' bed-shared, 28% (192/678) did so 'intermittently' and 28% (187/678) did so 'often'. These three groups did not differ significantly in marital status, income, infant gestational age, maternal age or delivery mode. Significantly, more participants who bed-shared 'often' reported strong prenatal breastfeeding intent (70% vs. 57% and 56% for 'intermittent' and 'rare' bed-share groups) and attached high prenatal importance to breastfeeding (95% vs. 87% and 82%). Significantly, more women who bed-shared frequently were breastfeeding at 6 months (p < 0.0001) than those who intermittently or rarely/never bed-shared.

CONCLUSION

Women with strong motivation to breastfeed frequently bed-share. Given the complex relationship between bed-sharing and sudden infant death syndrome (SIDS) appropriate guidance balancing risk minimisation with support for breastfeeding mothers is crucial.

Factors associated with breastfeeding duration and exclusivity in mothers returning to paid employment postpartum

Mothers who are employed postpartum are less likely to continue breastfeeding than mothers who are not formally employed. However, as postpartum employment is increasingly necessary for the majority of new mothers, it is important to investigate factors that influence the continuation of breastfeeding in employed mothers. A sample of 1,738 mothers who returned to paid employment postpartum were recruited from the obstetric units of four public hospitals in Hong Kong, and prospectively followed for 12 months or until their infant was weaned. More than 85 % of participants returned to formal employment within 10 weeks postpartum, with over 90 % of these employed full-time. About one-third of the participants (32 %) were able to combine breastfeeding and employment, with breastfeeding defined as continuing for more than 2 weeks after returning to work postpartum. Later return to work and higher maternal education were associated with new mothers being able to combine breastfeeding and employment. Later return to work, shorter working hours, parental childcare, and higher maternal education were also associated with less likelihood of weaning from any or exclusive breastfeeding. Improvements in employment-related conditions for mothers and additional support for lower educated mothers may be effective strategies to enable employed women to continue breastfeeding after their return to work.

Overcoming clinical barriers to exclusive breastfeeding

Although a large majority of US mothers now begin breastfeeding, exclusive breastfeeding rates fall far below national health objectives, with vulnerable populations being least likely to breastfeed exclusively. This article explores common personal and societal barriers to exclusive breastfeeding and offers evidence-based strategies to support mothers to breastfeed exclusively, such as ensuring prenatal education, supportive maternity practices, timely follow-up, and management of lactation challenges. The article also addresses common reasons nursing mothers discontinue exclusive breastfeeding, including the perception of insufficient milk, misinterpretation of infant crying, returning to work or school, early introduction of solid foods, and lack of support.