Breastfeeding, Parenting, and Infant Attachment Behaviors

Factors and interventions that positively influence breastfeeding rates at six months postpartum: An integrative literature review

BACKGROUND

Despite the health benefits of breastmilk, many women discontinue breastfeeding prior to six months postpartum. Previous work from 2010 has identified women's breastfeeding intention, self-efficacy, and support as the main modifiable factors that influence breastfeeding at six months postpartum. However, due to societal changes during the past decade, factors influencing women's decision to continue breastfeeding requires further exploration.

AIM

To determine "what modifiable contemporary factors and interventions can positively influence women's decision to continue breastfeeding until six months postpartum?"

METHOD

An integrative literature review was conducted based on Whittemore and Knafl's framework. Databases were searched using combinations of the following main key words: breastfeeding, duration, factors, and interventions. Studies addressing the research question and published in English language since 2010 were included. Interventional studies were limited to only randomised controlled trials.

RESULTS

Women's positive breastfeeding intention, self-efficacy, and support remained the key modifiable factors that could increase breastfeeding rates up to six months postpartum. The main effective interventions included education support or counselling when they targeted women's needs, intention, self-efficacy and support; and were held over multiple sessions commencing antenatally or immediately after birth. Contemporary effective strategies included digital communications such as phone calls, virtual meetings and messaging via social media including FacebookTM, WhatsAppTM and TelegramTM. Main conceptual frameworks were motivational interviewing, planned behaviour theory and cognitive behavioural therapy.

CONCLUSION

Interventions that support breastfeeding up to six months should include contemporary strategies that target the main modifiable factors and are tailored based to women's needs and their sociocultural influences.

Perinatal Intimate Partner Violence and Maternal-Infant Bonding in Women With Anxiety Symptoms in Pakistan: The Moderating Role of Breastfeeding

Intimate partner violence (IPV) during the perinatal period can negatively affect both a woman's health and the bonding with her infant. Research on IPV among pregnant women experiencing psychological distress in South Asia is limited. We examined associations between perinatal exposure to IPV and postnatal maternal-infant bonding in Pakistani women with symptoms of anxiety and assessed if breastfeeding practices moderated these associations. Postnatal data were collected from 720 Pakistani women who reported at least mild levels of anxiety symptoms in pregnancy. We performed Poisson regression with robust variance analyses to examine the associations between IPV during pregnancy or within 6 weeks after delivery (i.e., the perinatal period) and maternal-infant bonding. Interaction terms between IPV and breastfeeding practices were included in the analytic models to examine the moderating effects. About 27% of women were exposed to at least one type of perinatal IPV. Women who were exposed to IPV were more likely to have moderate to severe postpartum anxiety (n = 57, 28.9% of IPV-exposed women), compared to those without IPV (n = 65, 12.4% of unexposed women; p value < .001). Compared to women not reporting IPV, women exposed to any IPV showed a 38% increase in Postpartum Bonding Questionnaire scores, suggesting higher likelihood of impaired bonding (risk ratio [RR] = 1.38, 95% confidence interval [CI] [1.21, 1.56]). Among women who initiated breastfeeding later than 1 hr post-delivery, IPV was associated with impaired bonding (RR = 1.09, 95% CI [1.06, 1.20]), whereas no association was present for women who initiated breastfeeding within 1 hr (RR = 1.03, 95% CI [0.98, 1.08]). In addition to the efforts to reduce IPV, encouraging IPV-exposed women to adhere to the breastfeeding guidelines (e.g., early breastfeeding) may enhance maternal-infant bonding.

The need for educational intervention for breastfeeding women and the professional practice of midwives in France to promote breastfeeding: A joint explanatory study

In France, breastfeeding prevalence is high at birth, but its continuation remains low compared with other high-income countries, despite worldwide public health recommendations. Midwives offer parenting classes in an experimental manner without considering the importance of education in their interventions. The objectives of this study were to identify the teaching strategies and learning environments offered by midwives and their effect on women's perception of usefulness and their breastfeeding competence, to assess midwives' perception of usefulness and their pedagogical competencies. A comparative mixed study of 20 hospital midwives and 53 breastfeeding women (at 3 and 30 days postpartum) was conducted between January and August 2022 in two maternity units in France. Comparing the two periods, positive effects were found about breastfeeding women's level of knowledge: usefulness of learning theoretical (p=0.01) and practical (p=0.00) knowledge; and their breastfeeding management: signs of lactation (p=0.00), breast engorgement (p=0.04), and behavior (p=0.04). It positively reinforced the development of self-esteem (p=0.00) and commitment to breastfeeding (p=0.00). Midwives expressed strong motivation to use an appropriate teaching strategy and provide a supportive learning environment for women to improve their educational interventions (mean motivation score 7.7/10). The study results can promote research to examine educational interventions modeled according to the theories in education. Critical realism can be used to evaluate these interventions to elucidate how a program based on educational engineering can contribute to breastfeeding promotion and achieving the 2030 goals of WHO.

CLINICAL TRIAL REGISTRATION

The study was registered on the official website of ClinicalTrials.gov.

IDENTIFIER

ID NCT05271812.

Exploring the role of home play and learning activities in socioemotional development at 36-months: Findings from a large birth cohort study

The purpose of this research was to examine the role of a range of play and learning activities in the home (e.g., painting, playing games, reading, singing and letters and numbers) in the socioemotional development of young children. While many previous studies have focused on the benefits of home learning activities for language and literacy outcomes, less research has examined the role of these individual activities in other aspects of development, such as prosocial behaviour. Using a bioecological framework, a secondary analysis of data from the nationally representative Growing Up in Ireland(GUI) Study was conducted. The sample consisted of 9793 children, aged 36 months (50.7 % male and 49.3 % female). The study examined if the frequency of engagement in different play activities predicted scores on measures of internalising, externalising and prosocial behaviours using the Strengths and Difficulties Questionnaire. Findings indicated that informal play activities such as games, painting and drawing, and reading predicted socioemotional development scores, in comparison with activities such as letter or number games, even after parental and other family factors are accounted for. The results also indicated that parent-child relationship factors of warmth, hostility and closeness are particularly important for socioemotional development. Findings are discussed in the context of Bronfenbrenner's bioecological model of development.

Associations Between Breastfeeding, Maternal Emotional Availability, and Infant-Mother Attachment: The Role of Coparenting

BACKGROUND

Breastfeeding is a parenting practice that combines close intimate contact with the opportunity to be sensitive and responsive to the infant, and may have direct and indirect relations with infant attachment. However, researchers have produced inconsistent findings, suggesting there may be other mechanisms involved. Coparenting may play a significant role, as it has been consistently associated with mother-infant relationships.

RESEARCH AIMS

The aims of this study were to examine: (1) whether breastfeeding would be directly associated with infant-mother attachment; (2) whether this association was also indirect, through mothers' quality of caregiving; and (3) whether partners' coparenting support moderates breastfeeding's indirect association with attachment.

METHODS

This was a prospective, longitudinal study that drew data from a larger NIH-funded study on sleep and family relationships (R01HD052809). Mothers reported on their feeding practices and coparenting relationships. Independent observations were used to assess mothers' emotional availability toward infants. A separate team of observers assessed infant-mother attachment.

RESULTS

Exclusive breastfeeding during the first 6 months, and longer duration of any breastfeeding across the 1st year, were directly associated with more secure infant-mother attachment. These associations were also indirect, through maternal emotional availability. Coparenting was a significant moderator, such that the influence of longer breastfeeding duration on improved emotional availability, and, in turn, on more secure attachment, was significant only for mothers who perceived coparenting quality to be low.

CONCLUSION

Findings highlighted the importance of breastfeeding on both the quality of mothering and infant attachment, but also emphasized that coparenting support may be particularly important for mothers who are unable to breastfeed.

'It's far from the norm': breastfeeding beyond 1 year in the Republic of Ireland

Breastfeeding is the optimal form of nutrition for infants and young children. The World Health Organization recommends that babies are breastfed exclusively for the first 6 months of life, and up to the age of 2 years or beyond in combination with complementary food. Breastfeeding initiation and continuation rates are suboptimal globally and very low in the Republic of Ireland where health promotion initiatives and healthcare professional support predominantly focus on the important phase of initiation and early months of the breastfeeding journey. This qualitative descriptive study aimed to explore the experiences of women who chose to breastfeed their children beyond 1 year of age in the Republic of Ireland. Fourteen women participated in semi-structured interviews. Interviews were transcribed verbatim and thematic analysis was conducted. The analysis generated three overarching themes: (1) Influences on breastfeeding beyond 1 year, (2) Sustaining breastfeeding and (3) Benefits of breastfeeding beyond 1 year. Family, friends, peers, culture and commercial milk formula marketing had an influence on breastfeeding journeys. Support, determination, knowledge, bed-sharing and Covid-19 pandemic social restrictions helped to sustain breastfeeding beyond 1 year. Benefits of breastfeeding beyond 1 year such as nutrition, strengthening of emotional bonds, development of a parenting tool, and protection of child and maternal health were identified. Our findings support the need for discussions and further research on the normalization of breastfeeding beyond 1 year in the Republic of Ireland, targeted health promotion initiatives and education programmes for healthcare professionals on supporting the continuation of breastfeeding.

Breastfeeding and behavioral problems in five-year-old Japanese children: The Kyushu Okinawa Maternal and Child Health Study

PURPOSE

This prebirth cohort study examined the relationship between breastfeeding duration and behavioral problems in five-year-old Japanese children.

METHODS

Study subjects were 1198 mother-child pairs. Data were collected using a self-administered questionnaire. Emotional, conduct, hyperactivity, and peer problems and low prosocial behavior were assessed using the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

Neither exclusive breastfeeding duration nor breastfeeding duration regardless of exclusivity was significantly associated with childhood emotional, conduct, hyperactivity, or peer problems or low prosocial behavior. In children with older siblings only, ≥ 4 months of exclusive breastfeeding was significantly inversely associated with hyperactivity problems (adjusted odds ratio [OR] = 0.57, 95 % confidence interval [CI]: 0.31-0.99). In children without older siblings, ≥ 4 months of exclusive breastfeeding was inversely significantly associated with low prosocial behavior (adjusted OR = 0.54, 95 % CI: 0.30-0.93). No interactions were observed between exclusive breastfeeding duration and the presence of older siblings regarding the two outcomes.

CONCLUSIONS

No associations were found between breastfeeding duration and any of the outcomes based on the SDQ. Exclusive breastfeeding for ≥ 4 months may be inversely associated with hyperactivity problems in children with older siblings and with low prosocial behavior in children without older siblings.

Social representations of breastfeeding in health science students: A first step to strengthening their training

AIM

This study aims to describe the social representations of breastfeeding among Mexican health science students.

BACKGROUND

Breastfeeding is a complex phenomenon involving biological, affective and sociocultural aspects. Its definition includes diverse beliefs, attitudes, traditions and myths. Being aware of the connections between biological and sociocultural concepts in the social representations of breastfeeding in health science students may facilitate our comprehension of their attitudes/behaviors towards breastfeeding.

DESIGN

A qualitative study was carried out based on the structuralist approach of the social representations theory.

METHODS

Data were collected with free-listing questionnaires with breastfeeding as an inducer word among a random sample of nutrition, medical and nursing undergraduate students (n=124). The analyses used were similitude/meanings of words, prototypical and categorical analyses.

RESULTS

The findings suggest that the structure of the social representation is composed of breastfeeding essentials (baby, mother, & milk), affective (attachment, love & link), biological (nutrition, breasts, & health) and sociocultural elements (taboo, responsibility, & economic). Only instrumental elements are found in the nucleus, whereas biological, affective and sociocultural elements are observed in the peripheries. Moreover, emerging thematic categories such as the "affective bond" and "feeding" introduced additional dimensions, thereby emphasizing the complexity and richness of the social representation of breastfeeding in the context of health science students.

CONCLUSIONS

The structure of the social representation of breastfeeding among some Mexican undergraduate health science students focuses on the instrumental aspects, emphasizing essential elements. However, they downplay more scientifically oriented elements specific to their academic training. These findings, when extrapolated to different contexts, present an opportunity that could assist the development of tailored and culturally adapted educational strategies to strengthen breastfeeding training for health students. This approach can significantly contribute to enhancing breastfeeding promotion in society by addressing practical, scientific and language-inclusive aspects in the training of health professionals.

Examining psychosocial pathways to explain the link between breastfeeding practices and child behaviour in a longitudinal cohort

OBJECTIVE

Breastfeeding is associated with reduced postpartum depression, stronger parent-child relationships, and fewer behavioral disorders in early childhood. We tested the mediating roles of postpartum depression and parent-child relationship in the association between breastfeeding practices and child behavior.

STUDY DESIGN

We used standardized questionnaire data from a subset of the CHILD Cohort Study (n = 1,573) to measure postpartum depression at 6 months, 1 year and 2 years, parent-child relationship 1 year and 2 years, and child behavior at 5 years using the Child Behavior Checklist (range 0-100). Breastfeeding practices were measured at 3 months (none, partial, some expressed, all direct at the breast), 6 months (none, partial, exclusive), 12 months, and 24 months (no, yes). Confounders included birth factors, maternal characteristics, and socioeconomic status.

RESULTS

Breast milk feeding at 3 or 6 months was associated with - 1.13 (95% CI: -2.19-0.07) to -2.14 (95% CI: -3.46, -0.81) lower (better) child behavior scores. Reduced postpartum depression at 6 months mediated between 11.5% and 16.6% of the relationship between exclusive breast milk feeding at 3 months and better child behavior scores. Together, reduced postpartum depression at 1 year and reduced parent-child dysfunction at 2 years mediated between 21.9% and 32.1% of the relationship between breastfeeding at 12 months and better child behavior scores.

CONCLUSION

Postpartum depression and parent-child relationship quality partially mediate the relationship between breastfeeding practices and child behavior. Breastfeeding, as well as efforts to support parental mental health and parent-child relationships, may help to improve child behavior.

Breastfeeding experience of postnatal mothers separated from preterm infants after discharge: a phenomenology qualitative approach

BACKGROUND

Breastfeeding practices are influenced by the maternal-infant bond relationship. Mothers of preterm infants in the puerperium face many challenges and support is needed to maintain breastfeeding after hospital discharge. This study explored the breastfeeding experiences among mothers of preterm infants and challenges that influenced their breastfeeding practices.

METHODS

A qualitative phenomenological approach was used involving the mothers of preterm infants during the puerperium in Shanghai who fulfilled the inclusion criteria and consented to participate in the study. The mothers were recruited using purposive sampling. Eighteen participants were interviewed using semi-structured in-depth interviews. All interviews were recorded in digital audio, transcribed verbatim, and analyzed using thematic analysis.

FINDINGS

The breastfeeding experience among mothers of preterm infants included four themes: breastfeeding motivation, breastfeeding challenges, breastfeeding support and education, and response to parental stress. Breastfeeding challenges included perceived insufficient milk, bottle preference, and maternal-infant separation. Two sub-themes of breastfeeding support included breastfeeding knowledge and approach.

CONCLUSION

To overcome breastfeeding challenges and improve the breastfeeding rate of preterm infants after discharge, medical professionals must develop individualized breastfeeding plans based on a comprehensive assessment of the needs of mothers who delivered a preterm infant.

The Attitudes of Breastfeeding Mothers and Healthcare Professionals About Breastfeeding

Background

The attitudes of breastfeeding mothers and healthcare professionals greatly influence decisions about initiation of breastfeeding, duration of breastfeeding, and repeated breastfeeding in multiparous women.

Objective and Methods

This research aimed to examine, through a questionnaire, the attitudes of breastfeeding mothers and healthcare professionals about breastfeeding in the area covered by the district nurses of the Zagreb-West Health Center. 76 mothers and 74 healthcare professionals participated in the study, which was conducted during 2021.

Results

All healthcare professionals (100%) believe that breastfeeding in the first 6 months is important, and 97% of them believe that they are adequately educated about proper breastfeeding techniques. Furthermore, 98% of them believe that they provide mothers with all the necessary help and support regarding breastfeeding. 93% of healthcare professionals support breastfeeding in public. Most breastfeeding mothers were over 30 years old and had a higher level of education. Only 47% of women in the maternity unit had skin-to-skin contact, while 73% stayed in the room with their baby. In 89% of women, the first breastfeeding occurred within the first hour after birth. The greatest assistance during breastfeeding was provided to mothers by healthcare personnel (94%).

Conclusion

Continuous education of healthcare professionals and raising public awareness about the importance of breastfeeding must be a priority for every society.

Unraveling the effects of maternal breastfeeding duration and exclusive breast milk on children's cognitive abilities in early childhood

Background

This study investigated the putative associations between mothers' use of exclusive breast milk and the duration of breastfeeding with child cognitive development.

Methods

This study is based on 2,210 Canadian families with children assessed longitudinally from age 4 to 7 years on their memory-span and math skills. These cognitive abilities were measured with standardized tasks. Breastfeeding practices were collected via maternal reports. We applied propensity scores to control the social selection bias for breastfeeding.

Results

Results adjusted for propensity scores and sample weight revealed no significant differences between non-breastfed children with those being non-exclusively breastfed for 5 months or less, and with children being exclusively breastfed for 9.2 months on average, on their early math skills and memory-span. We found that children who were non-exclusively breastfed for 6.8 months on average had a slightly higher levels of memory-span at age 4 than children who were never breastfed, and this small but significant difference lasted up to age 7.

Conclusion

Our findings suggest no significant differences between children being exclusively breastfed and those fed with formula on their early math skills and memory-span. The encouragement of breastfeeding to promote child cognitive school readiness may, in some case (non-exclusive breastfeeding for more than 5 months), show a small but long-lasting advantage in early memory-span.

The effect of delayed umbilical cord clamping on the infant's beta-endorphin level, mother-infant attachment and breastfeeding

OBJECTIVES

To examine the effect of delayed umbilical cord clamping on the infant's betaendorphin level, mother-infant attachment and breastfeeding.

STUDY DESIGN

This study had an experimental design with a control group. The study was undertaken between October and December 2017 in a maternity hospital in the east of Turkey. In total, 107 pregnant women [55 in the experimental group (delayed cord clamping) and 52 in the control group (early cord clamping)] participated in the study.

RESULTS

The beta-endorphin level in the umbilical cord was 775.80 ± 229.35 in the experimental group and 547.91 ± 290.01 in the control group, and the difference was significant (t = 4.492, p = 0.000). Similarly, the prolactin level in the umbilical cord was 174.26 ± 47.20 in the experimental group and 119.06 ± 47.74 in the control group, and the difference was significant (t = 6.012, p = 0.000). Mother-infant attachment and breastfeeding success were higher in the experimental group.

CONCLUSIONS

Beta-endorphin and prolactin levels in the umbilical cord, mother-infant attachment and breastfeeding success were higher in the group which underwent delayed cord clamping.

Concept analysis of maternal-infant attachment during the weaning process

BACKGROUND

At the time that the mother and baby transit from breastfeeding to weaning, maternal-fetal attachment becomes a crucial basis for maintaining their emotional relationship. Conceptualization is needed to better understand the phenomenon of maternal-infant attachment during the weaning process.

OBJECTIVE

The purpose of this paper is to explore and identify the essence of the term maternal-infant attachment during weaning and to arrive at an operational definition of the concept.

METHOD

Concept analysis following Walker and Avant.

RESULTS

The attributes of maternal-infant attachment during the weaning process include (1) consistent and properly timed, (2) dynamic transactional interaction, and (3) secured adjustment. Maternal-infant attachment during the weaning process is brought by maternal sensitivity, closeness and proximity seeking, gentle and positive weaning, and breastfeeding experiences, which later turn into favorable emotion regulation, maturity, self-efficacy, secured bond, less intrusive interaction, resilience, and child's behavioral and development.

CONCLUSION

This concept analysis provides new insight into maternal-infant attachment during the weaning process that guides the nursing practice. Also, the findings can help develop or improve the models, theories, and instruments collected for maintaining maternal-fetal attachment during the weaning process.

Breastfeeding practices for infants with inherited metabolic disorders: A survey of registered dietitians in the United States and Canada

Background

Objective

Design

Results

Conclusions

Early Life Exposure to a Diet With a Supramolecular Lipid Structure Close to That of Mammalian Milk Improves Early Life Growth, Skeletal Development, and Later Life Neurocognitive Function in Individually and Socially Housed Male C57BL/6J Mice

Breastfeeding (duration) can be positively associated with infant growth outcomes as well as improved cognitive functions during childhood and later life stages. (Prolonged) exposure to optimal lipid quantity and quality, i.e., the supramolecular structure of lipids, in mammalian milk, may contribute to these beneficial effects through nutritional early-life programming. In this pre-clinical study, we exposed male C57BL/6J mice from post-natal Days 16 to 42 (i.e., directly following normal lactation), to a diet with large lipid droplets coated with bovine milk fat globule membrane-derived phospholipids, which mimic more closely the supramolecular structure of lipid droplets in mammalian milk. We investigated whether exposure to this diet could affect growth and brain development-related parameters. As these outcomes are also known to be affected by the post-weaning social environment in mice, we included both individually housed and pair-wise housed animals and studied whether effects of diet were modulated by the social environment. After Day 42, all the animals were fed standard semi-synthetic rodent diet. Growth and body composition were assessed, and the mice were subjected to various behavioral tests. Individual housing attenuated adolescent growth, reduced femur length, and increased body fat mass. Adult social interest was increased due to individual housing, while cognitive and behavioral alterations as a result of different housing conditions were modest. The diet increased adolescent growth and femur length, increased lean body mass, reduced adolescent anxiety, and improved adult cognitive performance. These effects of diet exposure were comparable between individually and socially housed mice. Hence, early life exposure to a diet with lipid droplets that mimic the supramolecular structure of those in mammalian milk may improve adolescent growth and alters brain function in both socially and individually housed mice. These findings suggest that lipid structure in infant milk formula may be a relevant target for nutritional solutions, targeting both healthy infants and infants facing growth challenges.

Birth Experiences, Breastfeeding, and the Mother-Child Relationship: Evidence from a Large Sample of Mothers

BACKGROUND

It is a priority for public health professionals to improve global breastfeeding rates, which have remained low in Western countries for more than a decade. Few researchers have addressed how maternal perceptions of birth experiences affect infant feeding methods. Furthermore, mixed results have been shown in research regarding breastfeeding and mother-child bonding, and many studies are limited by small sample sizes, representing a need for further investigation.

PURPOSE

We aimed to examine the relationship between subjective birth experiences and breastfeeding outcomes, and explored whether breastfeeding affected mother-infant bonding.

METHODS

3,080 mothers up to three years postpartum completed a cross - sectional survey.

RESULTS

Mothers who had more positive birth experiences were more likely to report breastfeeding their babies. Moreover, mothers who perceived their birth as more positive were more likely to breastfeed their child for a longer period (over 9 months) than those who had more negative experiences. In line with recent research, breastfeeding behaviours were not associated with reported mother-infant bonding.

CONCLUSIONS

Mothers who reported better birth experiences were most likely to breastfeed, and breastfeed for longer. We find no evidence to suggest that feeding methods are associated with bonding outcomes.

PREVENTIVE EXAMINATIONS OF CHILDREN IN DIFFERENT COUNTRIES: SIMILARITIES AND DIFFERENCES

OBJECTIVE

The aim: The aim of this study was to compare, analize and establish differences the recommendations for well-child visits and screenings till the age of 5 years in different countries .

PATIENTS AND METHODS

Materials and methods: The comparative analysis of the data from governmental recommendations for pediatricians from Germany, Ukraine and Poland is conducted. It was used the guideline for medical care for a child under 3 years (The Order №149) and for a healthy child from 4 to 18 years (The Order №434) in Ukraine, the book «Kinderuntersuchungsheft» in Germany and child's examination book «Książeczka zdrowia dziecka» in Poland.

RESULTS

Results: The number of visits to children by the doctors in Ukraine is 1.5-2 times higher than in other countries and the nurses visit are absent in Germany. The neonatal screening for genetic and metabolic diseases, updated in 2021 in Ukraine, corresponds to such screenings in other countries. Physical examination is performed in accordance with WHO standards in Ukraine, while in Poland and Germany the growth references are specially developed for the pediatric population. There was a difference in the age of hearing screening, examination of the hip joints, tactics for assessing vision by a pediatrician. The use of vitamin D, fluoride, iodine and vitamin K is recommended in Poland and Germany from the birth, while in Ukraine only vitamins are used.

CONCLUSION

Conclusions: It was found that the differences and similarities in preventive program in Ukraine, Poland and Germany. The results of this study may be useful for improving primary pediatric care.

Factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women: a multi-centre study

OBJECTIVE

To identify factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women.

DESIGN

Prospective cohort of mothers and infants born from 2008 to 2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study.

SETTING

General community setting in four Canadian provinces.

PARTICIPANTS

In total, 3455 pregnant women from Vancouver, Edmonton, Winnipeg and Toronto between 2008 and 2012.

RESULTS

Of 3010 participants included in the current study, the majority were Canadian-born (75·5 %). Breast-feeding initiation rates were high in both non-Canadian-born (95·5 %) and Canadian-born participants (92·7 %). The median breast-feeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breast-feeding initiation and continuation were older maternal age, higher maternal education, living with their partner and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breast-feeding initiation, but not continuation at 6-month postpartum. Factors associated with non-initiation of breast-feeding and cessation at 6-month postpartum were maternal smoking, living with a current smoker, caesarean birth and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breast-feeding initiation and lower odds of breast-feeding continuation at 6 months, and older maternal age and recruitment site were associated with breast-feeding continuation at 6 months.

CONCLUSIONS

Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breast-feeding initiation rates, breast-feeding initiation and continuation are more strongly associated with socio-demographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breast-feeding continuation in both groups and may indicate geographic disparities in breast-feeding rates nationally.

Breastfeeding Self-efficacy and Related Socio-demographic, Perinatal and Psychological Factors: a Cross-sectional Study Among Postpartum Greek Women

Background:

Studies have shown that breastfeeding self-efficacy constitutes a determinant used to forecast breastfeeding behaviours.

Objective:

The aim of this study was to examine the factors associated to breastfeeding self-efficacy and identify its predictors among Greek women in their immediate postpartum period.

Methods:

A cross-sectional study was conducted at the General Hospital of Volos, Greece. A convenience sample of 120 postpartum women who gave birth at the hospital and met all the inclusion criteria were invited to participate; 100 responded. Questionnaires on socio-demographic, perinatal and breastfeeding-related characteristics, the Edinburgh Postnatal Depression Scale, and the Breastfeeding Self-Efficiency Scale were completed. Univariate and multivariate analyses were performed with the use of the linear regression model.

Results:

Women reported a rather good level of breastfeeding self-efficacy (mean = 3.65; SD = 0.85) in the early postpartum period. 52% of women carried out exclusive breastfeeding in the hospital. The prevalence of postnatal depression was 25%. The best-fit regression analysis revealed four predictors (timing of the mother’s decision to breastfeed, infant’s feeding pattern, previous breastfeeding experience, levels of postnatal depression) explaining 44.7% of the variance in breastfeeding self-efficacy.

Conclusion:

Acknowledging the determinants which affect breastfeeding self-efficacy of women in the immediate postpartum period is a necessary condition in designing targeted intervention services.

Breastfeeding Experiences During the COVID-19 Lockdown in the United Kingdom: An Exploratory Study Into Maternal Opinions and Emotional States

BACKGROUND

The COVID-19 pandemic has hugely impacted upon people's psychological and physical wellbeing; however, the effects of the COVID-19 lockdown on mothers of young children, with particular regard to breastfeeding, are unknown.

RESEARCH AIMS

To explore: (1) Sources of advice and support available to breastfeeding mothers during and prior to the COVID-19 lockdown; (2) Mothers' opinions on statements and recommendations made by the World Health Organization on the importance of breastfeeding and breastfeeding during the COVID-19 pandemic; (3) Maternal emotional states (i.e., anxiety and depression symptoms) experienced by breastfeeding mothers during the COVID-19 lockdown; and (4) influence of breastfeeding duration and number of children on breastfeeding opinions and emotional states.

METHODS

Mothers of children aged 0-36 months (N = 4018) took part in an online survey. The survey included demographic questions, as well as the Generalised Anxiety Disorder Questionnaire and the Patient Health Questionnaire. Mothers were further probed on opinions regarding breastfeeding practices during the COVID-19 pandemic.

RESULTS

Participants strongly agreed with the importance of breastfeeding, even if a mother showed symptoms of COVID-19. Differences in opinions on breastfeeding practices (e.g., the use of donor human milk and relactation), were found between participants in relation to breastfeeding duration and number of children. Participants with more than one child showed higher negative emotional states, namely anxiety symptoms. Except for Internet usage, participants indicated a decline in all sources of advice and support for breastfeeding during the COVID-19 lockdown.

CONCLUSIONS

Health bodies and professionals should consider maternal viewpoints and opinions regarding breastfeeding during the COVID-19 pandemic. Interventions are urgently needed in order to support breastfeeding mothers and prevent the development of mental health issues.

"It Is a Very Emotional Topic for Me"-Managing Breastfeeding Problems among German Mothers: A Qualitative Approach

Breastfeeding is associated with positive health outcomes for both child and mother. Nevertheless, some women experience breastfeeding problems which commonly lead to early cessation, or not starting breastfeeding at all. Our aim was to explore how women that have difficulties in breastfeeding perceive their situation and how they actively manage it. We conducted semi-structured interviews with 15 mothers living in Germany who had experienced breastfeeding problems. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Breastfeeding problems occurred due to different reasons and had a huge impact, as evidenced in the four main themes of the findings: individual situation, managing the situation, perceived consequences for relations, feelings, and potential future pregnancies, and perceived health consequences for the mother. They frequently experienced negative emotions, including psychological distress and mental health problems, with perceived negative consequences for the mother-infant-bonding. Trying to actively manage the situation and availability of social support seemed to have a relieving effect, whereas confrontation and lack of understanding worsened the situation. Breastfeeding problems and the inability to breastfeed can have a great influence on maternal well-being. These can affect different aspects of a mother's life, including the attachment to the child. Providing support for actively managing the situation and supporting the exchange of experience between mothers who perceive breastfeeding problems may help mothers to better deal with their situation. Our findings may help health professionals to understand what these mothers feel and how they can support these women in a sensitive way.

Effects of active and/or passive smoking during pregnancy and the postpartum period

INTRODUCTION

Tobacco smoking may cause adverse effects during pregnancy and postpartum. The aim of this study was to evaluate several repercussions of active and/or passive smoking by the mother at home, during pregnancy, at delivery, as well as for the newborn baby and breastfeeding, including the effect of quitting smoking in the first trimester of pregnancy.

METHODS

A prospective longitudinal study was carried out with a sample of 800 pregnant women. Four evaluations were made: first and third trimester of pregnancy, and 2 and 6/8 months postpartum. Sociodemographic, obstetric, health and tobacco consumption details were collected, with biochemical tests being performed to confirm the self-reported abstinence.

RESULTS

Being an active and passive smoker predicted suffering complications in pregnancy (OR 2.50; 95% CI; 1.42-4.35) and delivery (OR 3.10; 95% CI; 1.75-5.51), and also tended not to breastfeed (OR 2.44; 95% CI; 1.35-4.42). Being an active smoker predicted complications at childbirth (OR 5.58; 95% CI; 2.64-7.77), for the baby (OR 3.77; 95% CI; 1.53-9.36) and not breastfeeding at 2 (OR 25.73; 95% CI; 11.95-55.40), and 6/8 months postpartum (OR 6.61; 95% CI; 3.21-13.58). Being a passive smoker reduces the intend to breastfeed (OR 1.81; 95% CI; 1.11-2.95), and the practice of breastfeeding at 2 months postpartum (OR 1.94; 95% CI; 1.11-3.37). Women who quit smoking are less likely to suffer complications in pregnancy and childbirth, and are more likely to attend antenatal and breastfeeding classes, and to have babies with higher birth weight.

CONCLUSIONS

Active and passive tobacco consumption has significant implications during pregnancy and postpartum period. Smoking cessation at the beginning of pregnancy reverses much of these effects.

Breastfeeding, Early Self-Regulation, and Academic Achievement in Kindergarten Among Disadvantaged Children

OBJECTIVES

The importance of breastfeeding exposure and children's development of self-regulation, independently, are well established. Each of these domains also has been linked to better cognitive development and academic achievement in children. However, little is known about how breastfeeding affects development of early self-regulation skills or whether self-regulation mediates the relationship between breastfeeding and academic achievement, particularly for disadvantaged children. This study examined breastfeeding exposure, self-regulation, and academic achievement in kindergarten among a population of children who previously attended Head Start.

METHODS

Children were recruited from Head Start classrooms in the Pacific Northwest. Breastfeeding exposure was assessed via parent report. Children's self-regulation (Day Night Stroop, Dimensional Change Card Sort, Head-Knees-Toes-Shoulders-Revised) and academic achievement [Letter-Word Identification and Applied Problems subtests of Woodcock Johnson Tests of Achievement (English) or the Batería III Woodcock-Muñoz (Spanish)] were directly assessed in fall and spring of kindergarten. Regressions were performed using Stata v14.1 and included breastfeeding exposure as the primary independent variable, controlling for child age, sex, and language spoken.

RESULTS

Of the 246 children, 56% were reported as White, 34% Latino/a, 4% African American, and 6% other; 83% were ever exposed to breastfeeding. Breastfeeding exposure was predictive of both fall kindergarten academic achievement (emergent math/literacy scores) and self-regulation (p < 0.05) and related to higher math performance in the spring of kindergarten, which was associated with stronger self-regulation in the fall (p = 0.04).

CONCLUSIONS

These findings extend our understanding of the positive effects of breastfeeding exposure on children's development and support breastfeeding promotion, particularly for children at risk of academic difficulty.

Maternal Schizophrenia, Skin-to-Skin Contact, and Infant Feeding Initiation

BACKGROUND

The World Health Organization recommends mothers and infants be in direct skin-to-skin contact immediately after birth and initiate breastfeeding as soon as possible. Little is known in women with schizophrenia.

METHODS

We conducted a population-based cohort study using administrative health data from Ontario, Canada (2012-2014), comparing women with (n = 471) and without schizophrenia (n = 218 435), and their infants, on the primary outcomes of any skin-to-skin contact and opportunity to initiate breastfeeding within the first 2 h after birth. For dyads with available data, secondary outcomes of intention to breastfeed, breastfeeding support, any breastmilk, and exclusive breastmilk at discharge were assessed. Modified Poisson regression was used to generate relative risks (aRR) and 95% confidence intervals (CI), adjusted for maternal age, parity, neighbourhood income, region of residence, smoking in pregnancy, and maternal medical and non-psychotic psychiatric comorbidity for all outcomes.

RESULTS

Maternal schizophrenia was associated with lower likelihood of skin-to-skin contact (65.2% vs 78.1%; aRR 0.88, 95% CI: 0.82-0.94), and breastfeeding initiation post-delivery (38.9% vs 52.6% aRR 0.80, CI: 0.71-0.90) compared to dyads unexposed to maternal schizophrenia. Secondary outcomes followed a similar pattern. The magnitude of the effect was slightly less when restricting the cohort to full-term, vaginal deliveries, not admitted to NICU, and infant not discharged to social services.

CONCLUSIONS

Reduced maternal-infant skin-to-skin contact and breastfeeding initiation immediately after birth may significantly impact maternal-child bonding and the establishment breastfeeding in this population. Mothers with schizophrenia may require individualized support to promote these WHO recommended hospital practices in the early post-natal period.

Demographic, socioeconomic, and sociocultural factors associated with any breastfeeding in homeless mothers

In high-income countries, breastfeeding has been shown to be positively associated with socioeconomic position. However, less is known about breastfeeding practices and their associated factors among extremely disadvantaged populations. We aimed to assess the associations of cultural origins and socioeconomic factors with any breastfeeding initiation and duration in homeless families. We analyzed data from 456 children aged 6 months to 5 years from the cross-sectional ENFAMS survey, conducted in 2013 among a random sample of homeless families in shelters in the Greater Paris area. Data were collected by bilingual interviewers in 17 languages. Four nested multivariable robust Poisson regression models were run in a hierarchical framework to determine the factors associated with breastfeeding initiation and with any breastfeeding for 6 months or more. Most of the children (86.0%) had previously been or were currently being breastfed at the time of the survey; 58.9% were fed with breast milk ≥6 months. A higher maternal age and African origin were positively associated with breastfeeding ≥6 months, although the relation to the region of origin was moderated by education level. Migration to escape war, unrest or other violence and the child's birth in France were inversely associated with breastfeeding ≥6 months. Any breastfeeding by these homeless mothers seems influenced predominantly by their cultural origin and complicated by a difficult migration trajectory. The possible influence of poor material circumstances and cumulative hardship should encourage interventions targeted at homeless mothers that emphasize social/family support with a commitment to improving the family's living conditions.

A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression

INTRODUCTION

Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied.

METHODS

In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum.

RESULTS

Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness.

CONCLUSIONS

In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.

Postpartum depression and mother-offspring conflict over maternal investment

BACKGROUND AND OBJECTIVES

As the mother-offspring relationship is central to human reproduction, postpartum depression symptoms are difficult to explain in evolutionary terms. We proposed that postpartum depression might arise as a result of evolutionary mother-offspring conflict over maternal investment, and investigated the association between postpartum depression symptoms, infant night waking, maternal sleep disturbance and breastfeeding frequency.

METHODOLOGY

We conducted a cross-sectional analysis using survey responses at 6 months postpartum from 1598 Finnish mothers. We hypothesized that infant night waking at 6 months postpartum would be associated with postpartum depression symptoms, and that this association would be mediated by maternal sleep disturbance and a higher breastfeeding frequency.

RESULTS

Infant night waking was moderately associated with postpartum depression symptoms, and this association was mediated by maternal sleep disturbance (R 2=0.09). Contrary to our prediction, we found that increased breastfeeding was associated with less postpartum depression symptoms.

CONCLUSIONS AND IMPLICATIONS

We conclude that postpartum depression symptoms might partly be the result of increased maternal fatigue stemming from high offspring demands on maternal investment, but that this is not due to the metabolic strain from increased breastfeeding. Studying postpartum depression from the mother-offspring conflict perspective can potentially improve our understanding of the involved behavioral processes of both mother and offspring, and allow interventions designed to benefit the well-being of both parties. Lay Summary: We proposed that postpartum depression is due to an evolutionary conflict between mother and infant, where the infant tires the mother to delay the arrival of a sibling. We found a link between infant night waking and postpartum depression, mediated by the mother's sleep, but not by breastfeeding frequency.

Predictors of maternal attachment among breastfeeding mothers in Jordan

Aim

This study aims to investigate the difference in maternal attachment in different scenarios, that is among mothers who breastfed their infants and mothers who combined breastfeeding with other types of feeding and determine the predictors of maternal attachment in breastfeeding mothers.

Design

A survey was used to collect data from 222 mothers from Jordan University of Science and Technology in Jordan.

Method

Who used breastfeeding or mixed methods and had healthy infants aged from 3 to 12 months and who did not have postpartum complications. The survey was conducted in three healthcare centres in Irbid city, Jordan.

Results

Mothers only breastfeed their infants did not differ in their attachment compared with those who used mixed feeding methods (using breastfeeding with formula feeding). Many factors showed significant impact on maternal attachment, which includes the mother's education, if they have assistance in caring for their infant, marital relationship quality, the infant's gender and the planning for pregnancy.

A breastfeeding support program changed breastfeeding patterns but did not affect the mothers' self-efficacy in breastfeeding at two months

BACKGROUND

Even though the biological norm in humans is frequent on demand breastfeeding, sparse feeding intervals have become the cultural norm in most Western countries due to a history of on schedule breastfeeding. This discrepancy between the biological basis and the culturally driven practice continues to interfere with women's ability to breastfeed.

AIM

Our aim was to describe breastfeeding patterns in 2-month-old infants before and after the implementation of a breastfeeding support program. A secondary aim was to investigate the relationship between breastfeeding patterns and the mother's self-efficacy in breastfeeding.

METHODS

The study had a baseline/intervention design and was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding program. The larger project included breastfeeding training for health care professionals and provision of breastfeeding information to parents, including information about on demand breastfeeding. Data were gathered via breastfeeding diaries (n = 79 mothers from each group) and the Breastfeeding Self-efficacy Scale-Short Form (n = 83 in the baseline group and n = 79 in the intervention group).

RESULTS

On demand breastfeeding patterns were more common in the intervention group (97.5%) than in the baseline group (74.7%) (p < 0.001), and breastfeeding sessions were more frequent in the intervention group (a median of 14 times per 24 h versus 11 times in the baseline group; p = 0.026). Self-efficacy in breastfeeding did not differ between the groups, but was higher in mothers with exclusive breastfeeding.

CONCLUSIONS

Knowledge about infants' breastfeeding behavior can strengthen on demand breastfeeding. Exclusive breastfeeding is associated with higher self-efficacy.

[Effects of active and/or passive smoking during pregnancy and the postpartum period]

INTRODUCTION

Tobacco smoking may cause adverse effects during pregnancy and postpartum. The aim of this study was to evaluate several repercussions of active and/or passive smoking by the mother at home, during pregnancy, at delivery, as well as for the new born baby and breastfeeding, including the effect of quitting smoking in the first trimester of pregnancy.

METHODS

A prospective longitudinal study was carried out with a sample of 800 pregnant women. Four evaluations were made: first and third trimester of pregnancy, and 2 and 6/8 months postpartum. Sociodemographic, obstetric, health and tobacco consumption information was collected, with biochemical tests being performed to confirm the self-reported abstinence.

RESULTS

Being an active and passive smoker predicted suffering complications in pregnancy (OR 2.50; 95% CI; 1.42-4.35) and delivery (OR 3.10; 95% CI; 1.75-5.51), and also intend not to breastfeed (OR 2.44; 95% CI; 1.35-4.42). Being an active smoker predicted complications at childbirth (OR 5.58; 95% CI; 2.64-7.77), for the baby (OR 3.77; 95% CI; 1.53-9.36) and not breastfeeding at 2 (OR 25.73; 95% CI; 11.95-55.40), and 6/8 months postpartum (OR 6.61; 95% CI; 3.21-13.58). Being a passive smoker reduces the intention to breastfeed (OR 1.81; 95% CI; 1.11-2.95), and the practice of breastfeeding at 2 months postpartum (OR 1.94; 95% CI; 1.11-3.37). Women who quit smoking are less likely to suffer complications in pregnancy and childbirth, and are more likely to attend antenatal and breastfeeding classes, and to have babies with higher birth weight.

CONCLUSIONS

Active and passive tobacco consumption has significant implications during pregnancy and postpartum period. Smoking cessation at the beginning of pregnancy reverses much of these effects.

Maternal odor reduces the neural response to fearful faces in human infants

Maternal odor is known to play an important role in mother-infant-interaction in many altricial species such as rodents. However, we only know very little about its role in early human development. The present study therefore investigated the impact of maternal odor on infant brain responses to emotional expression. We recorded the electroencephalographic (EEG) signal of seven-month-old infants watching happy and fearful faces. Infants in two control groups exposed to no specific odor (control 1) or the odor of a different infant’s mother (control 2) showed the expected EEG fear response. Crucially, this response was markedly absent in the experimental group exposed to their mother’s odor. Thus, infants respond differently to fear signals in the presence of maternal odor. Our data therefore suggest that maternal odor can be a strong modulator of social perception in human infants.

Investigation of the Relationship Between Maternal Attachment and Breastfeeding Self-Efficacy and Affecting Factors in Turkish Sample

PURPOSE

This research aimed to investigate the factors affecting the perception of mothers about breastfeeding self-efficacy and their maternal attachment between the fourth and eighth postnatal weeks and their relation.

DESIGN AND METHODS

This research, which is descriptive, was conducted on 351 postpartum women between December 2017-2018. The study used the Mother Descriptive Information Form, Maternal Attachment Inventory (MAI), and the Short Form of the Breastfeeding Self-Efficacy Scale (BSES-SF).

RESULTS

It was found that, mothers' mean scores on the BSES-SF and MAI were affected by their educational level, the status of regular health checkups during the last pregnancy, the number of visits for health checkups during the last pregnancy, the place where they held their babies, the status of breastfeeding previous babies, prenatal breastfeeding training, the status of finding their own breast milk sufficient, the time when they first breastfed the baby, the first food the baby received, the status of being willing to breastfeed, the status of having fatigue due to breastfeeding, the planned duration of breastfeeding, the status of using additional infant formula, and the status of having a close relative or friend also breastfeeding. It was also determined that there was a low positive relationship between breastfeeding self-efficacy and maternal attachment.

CONCLUSIONS

The level of breastfeeding self-efficacy and maternal attachment status of mothers should be determined in the postpartum period, and health personnel should intervene on alterable factors that adversely affect breastfeeding self-efficacy and attachment status, especially in mothers at risk.

Effect of recorded maternal voice on emergence agitation in children undergoing bilateral ophthalmic surgery: A randomised controlled trial

AIM

This study was designed to investigate whether the playing-back of the recorded maternal voice through the headphones to children undergoing bilateral ophthalmic surgery has clinical effects on the incidence of emergence agitation, and the anaesthesia recovery course.

METHODS

In this prospective, blinded and randomised study, 127 children, aged 2-8 years and undergoing bilateral ophthalmic surgery were randomly allocated to one of the two groups: group T (treatment group, listening to recorded mother's voice via headphones) or group C (control group, wearing headphones without auditory stimuli). The primary outcome was the incidence of emergence agitation, and the secondary outcomes were the awakening time, and the post-anaesthesia care unit (PACU) stay time.

RESULTS

Children in the group of listening recorded mother's voice exhibited significantly low incidence of emergence agitation compared with those in the control group (32.8 vs. 55.6%; odds ratio (95% confidence interval): 0.39(0.19-0.80); P = 0.010). The awakening time was shorter in group T as compared to that in group C (22.9 (10.4) vs. 27.3 (13.7); P = 0.048). As results, the group T had significantly less PACU stay time with early discharge than the group C did (29.7 (12.1) vs. 34.8 (14.1); P = 0.031).

CONCLUSIONS

Recorded mother's voice is an efficient method to reduce emergence agitation in children undergoing bilateral ophthalmic surgery with sevoflurane anaesthesia. Also, patients woke faster and PACU stay time was shorter in the mother's voice group as compared with the control group.

Understanding the Challenges of Induction of Lactation and Relactation for Non-Gestating Spanish Mothers

BACKGROUND

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

RESEARCH AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

UK mothers' experiences of bottle refusal by their breastfed baby

Little is known about bottle refusal by breastfed babies; however, an informal review of global online forums and social media suggested large numbers of mothers experiencing the scenario. This study aimed to explore UK mothers' experiences of bottle refusal by their breastfed baby in order to provide understanding of the scenario and enhance support for mothers experiencing it. A 22‐point online questionnaire was developed and completed by 841 UK mothers. Findings suggest that mothers introduced a bottle to their breastfed baby due to physical, psychological and socio‐cultural factors. Advice and support for mothers experiencing bottle refusal was not always helpful, and 27% of mothers reported bottle refusal as having a negative impact on their breastfeeding experience. When compared with eventual bottle acceptance, bottle refusal was significantly associated with previous experience of bottle refusal (p < .001), how frequently mothers intended to feed their baby by bottle and babies being younger at the first attempt to introduce a bottle (p < .001). This study provides a unique insight into the complexities of bottle refusal by breastfed babies and the impact it can have upon mothers' breastfeeding experiences. It generates knowledge and understanding that can help to inform practice and policies. In addition, a ‘normalising’ of the scenario could enable mothers, and those supporting them, to view and manage it more positively.

The Effect of Maternal Depression on Infant Attachment: A Systematic Review

Aims and objectives: The aim of this systematic review was to summarize the key findings of empirical studies assessing the influence of maternal depression on child attachment security measured before 24 months after birth. Method: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A literature search was conducted on the EBSCO (Academic Search Complete; Health Source: Nursing/Academic Edition; MEDLINE; PsycARTICLES) and PubMed databases, with infant attachment AND depression as search terms with Boolean operators. Study design or sample size did not affect inclusion. After screening, 29 of the 1510 unique publications originally identified were included in the review. Results: The studies reveal an equivocal association between maternal depression and child attachment security. Our findings indicate that depression had a significant influence on the attachment style almost only when diagnosed by structured interview: Depression measured by self-descriptive questionnaires was unrelated to attachment style. Furthermore, postpartum depression was found to be significant only when measured up to six months after childbirth. Conclusion: The relationship between maternal depression and infant attachment is both complex and dynamic, and the possible negative effects of depression might be compensated by maternal involvement in childcare. Therefore, further studies in this area should employ a reliable methodology for diagnosing depression and a suitable time point for measuring it; they should also adopt a multifactorial and prospective approach. It is important to note that breastfeeding/formula feeding was omitted as a factor in the majority of studies.

Feeding and developmental outcomes of infants in a South African community

BACKGROUND

Prevalent environmental risk factors place infants in lower-middle-income countries (LMICs) at an increased risk for feeding and developmental difficulties.

AIM

This study aimed to determine the relationship between feeding and developmental outcomes in infants, as early feeding difficulties may have a cascading effect on developmental outcomes and vice versa.

METHODS

Data on 144 infants' feeding and development [mean age (standard deviation) = 8.8 months (2.2)] from a primary health care clinic in Gauteng, South Africa were retrospectively analysed.

RESULTS

Early introduction of cup feeding was found to be a predictor of possible expressive language and articulation difficulties. Gagging, spitting, or vomiting, pocketing, the use of force feeding, and poor sucking and chewing abilities were significantly associated with behavioural and social-emotional difficulties. Breastfeeding was found to be a protective factor for language development. The results emphasise the importance of primary prevention and early identification of risks in late infancy in LMIC.

Made to Feel Like Less of a Woman: The Experience of Stigma for Mothers Who Do Not Breastfeed

Background: Breastfeeding has become the recognized standard for good parenting, with social costs for not breastfeeding, but not every mother wants to or is able to breastfeed. Objectives: This study investigated social and personal costs with no breastfeeding. Materials and Methods: An in-depth survey was conducted with 250 mothers with infants who were not breastfeeding. Situated in the Framework Integrating Normative Influences on Stigma model for stigma, the study analyzed internalized stigma and perception of stigma from others, maternal feelings of warmth for the infant, and hiding formula use. Results: Mothers who chose not to breastfeed reported little personal or public stigma. In comparison, mothers who were unable to breastfeed experienced relatively more internalized stigma and perceived that other people saw them as failures. Mothers who experienced more internalized and perceived social network stigma were likely to hide use of infant formula from others and had lower feelings of warmth for their infants. Knowledge about formula use and availability of support resulted in less stigma and more warmth for the infant. Conclusions: These results suggest that public responses causing a mother to feel guilty for using infant formula result in negative feelings of self-worth and dysfunctional maternal behaviors.

Breastfeeding and the Development of Socio-Emotional Competencies: A Systematic Review

Aim: To assess the current scientific evidence about the relationship between breastfeeding and the development of infant's socio-emotional competencies. Materials and Methods: A systematic review of literature was conducted through PubMed, LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), and PsycINFO of population-based cohorts. Records were screened, data extracted, and a quality assessment performed by two authors independently. Results: Thirteen studies were included in the review with six finding a statistically significant association between breastfeeding and the development of socio-emotional competencies such as problem solving, agreeableness, and optimism. In five studies, no statistically significant association was found, and in three, a negative association existed. Regarding quality assessment, four studies had a strong global rating, four had a moderate rating, and five had a weak global rating. Conclusion: Almost half (6/13) of the studies found a positive association between breastfeeding and the development of social-emotional competencies in infants; however, a great heterogeneity was present in the quality of the included studies. There is a need for further and higher quality research into this field of study.

The association between breastfeeding and attachment: A systematic review

OBJECTIVE

In the popular and scientific literature an association between breastfeeding and attachment is often supposed although this has not been systematically investigated. This is the first review that provides a systematic overview of the current state of research on the association between breastfeeding and attachment. The objective is to determine whether breastfeeding is associated with child attachment as well as if maternal attachment is associated with breastfeeding behaviour.

DESIGN

A systematic electronic literature search for English language articles published from 1963 to 2019 using the databases Web of Science, PubMed, PsycInfo, and PsycArticles was conducted. Studies were included if (1) the association between breastfeeding and attachment of the child or maternal attachment style and breastfeeding was investigated, (2) participants were mothers or mother-child dyads, and (3) quantitative measures of breastfeeding and attachment were used. Study quality was rated using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

PARTICIPANTS

Studies examining mothers or mother-child dyads were reviewed. Sample sizes varied between N = 60 and N = 8900 participants. On average, mothers were between 27.56 and 32.50 years old.

FINDINGS

Eleven studies were eligible for inclusion. Of seven studies examining breastfeeding and child attachment, four found that a longer duration of breastfeeding was significantly associated with higher levels of attachment security after controlling for various covariates. No significant differences in attachment security between breastfeeding and bottle-feeding were reported, but one study found higher levels of attachment disorganization for bottle-feeding, although mean levels were below a clinically relevant level. The initiation of breastfeeding directly after childbirth was not related to child attachment. Of four studies examining maternal attachment and breastfeeding, three found a significant association between secure attachment of the mother and breastfeeding behaviour. Secure attached mothers initiated breastfeeding more often and preferred breast- over bottle-feeding than insecure attached mothers. Mixed results were found for breastfeeding duration. Most studies had limitations regarding adequate sample size, and valid and reliable measurement of breastfeeding.

KEY CONCLUSIONS

The findings provide some evidence that breastfeeding might contribute to child attachment security. Furthermore, maternal attachment style might play a role in breastfeeding behaviour. However, more prospective studies are needed to draw a solid conclusion.

IMPLICATIONS FOR PRACTICE

With regard to breastfeeding recommendations, health professionals should be aware of and communicate towards clients that the effect of breastfeeding on child attachment might be rather small. Screening of maternal attachment style as a part of maternity practice could be useful to support insecure attached mothers experiencing breastfeeding difficulties.

Associations Between Breastfeeding and Mother-Infant Relationships: A Systematic Review

Introduction: Breastfeeding has been associated to an improved mother-child bond, although this link is lacking the sufficient empirical support. Aims: The aims of this study were to carry out a systematic review as a continuation to the one by Jansen et al., and to clarify the link between breastfeeding and mother-infant relationships. Materials and Methods: Data sources: A search was conducted using PsycINFO, MEDLINE, and CINAHL (2008-2018), using both free text words and subject headings. Additional hand-searching was performed. Study selection: The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) framework guided (the reporting of) the study selection and data extraction. Eligible articles were subsequently selected by title, abstract, and full text review. Data extraction: Data regarding study setting, participants, breastfeeding, mother-infant relationships, and outcome measures were extracted in a systematic way. Results of Data Synthesis: Ultimately, 13 articles were included. Most studies were conducted in Europe (46.15%) and were nonexperimental studies (92.3%). Eight studies were longitudinal, using between two and five assessment time points. The instruments used to assess the bond between mother and child showed great variability. From the studies, 8 (61.5%) employed self-report measures and four assessed maternal perception. Others used open-ended questions regarding the maternal lactation process or about the mother's activity while breastfeeding. Other measures used were maternal perception of her baby and personality variables associated to breastfeeding. Five articles studied the bond using external observations of the interactions between mother-child. The quality of the studies (Medical Education Research Studies Quality Instrument [MERSQI]) was overall fair to good. Conclusion: It is complicated to extract generalizable results because of the conceptual and instrumental variability of the mother-child relationship. This association is complex and the way in which breastfeeding is carried out would appear to be a decisive factor, influenced in turn by additional variables that should also be taken into account. The relationship indicators most frequently associated to breastfeeding are maternal sensitivity and secure attachment.

Breastfeeding Support Guided by Swanson's Theory of Caring

PURPOSE

Many women struggle with initiation of breastfeeding. The purpose of this study was to explore mothers' perceptions of care and support received from clinicians during breastfeeding initiation and the utility of Swanson's (1991) Theory of Caring to provide person-centered care to breastfeeding mothers and infants.

STUDY DESIGN AND METHODS

Directed content of secondary analysis of data obtained from 11 women via in-person interviews at three time points: before birth, a week after giving birth, and 6 to 8 weeks after giving birth. All women were breastfeeding at the end of the study interview series. Swanson's Theory of Caring provided the theoretical framework for the analysis.

RESULTS

Two overarching themes The Acts of Caring and The Lapses in Caring summarized women's experiences of care received during the initiation of breastfeeding. Five subthemes supported the Acts of Caring theme, and three subthemes supported the Lapses in Caring theme.

CLINICAL IMPLICATIONS

Although all study participants chose to breastfeed after hospital discharge and the majority felt well supported, some received care that was perceived as uncaring, unsupportive, or harmful. Providing breastfeeding support consistent with research evidence and underpinnings of Swanson's Theory of Caring may help women build trusting relationships with clinicians and feel confident in meeting their breastfeeding goals.

Critical Review of Theory Use in Breastfeeding Interventions

BACKGROUND

Numerous efforts to promote breastfeeding resulted in a steady increase in the rates of breastfeeding initiation and duration. Increasing numbers of breastfeeding interventions are focused on breastfeeding maintenance and exclusivity and based on behavioral theories. Few studies critically analyzed the use of theories in breastfeeding intervention development and evaluation.

RESEARCH AIM

The aim of this critical review was to examine the existing literature about breastfeeding intervention, and investigate the role of theory in its development, implementation, and evaluation to provide future directions and implications for breastfeeding interventions.

METHODS

This critical review examined the existing breastfeeding intervention studies that used self-efficacy theories (SE), theory of planned behavior (TPB), and social cognitive theory (SCT) and were published during the past decade. Using five databases, studies in which researchers explicitly applied these three theories to frame the intervention were selected. Studies were critically reviewed for fidelity to theory in intervention design, delivery, and evaluation.

RESULTS

Eighteen studies were reviewed: nine SE-, five TPB-, and four SCT-based. Most interventions were focused on building mothers' breastfeeding self-efficacy to improve breastfeeding exclusivity and duration. To achieve this goal, researchers who developed SE-based interventions used individual approaches, whereas other researchers who based studies on TPB incorporated social and environmental changes. SE-based studies were more likely to include theory-based instruments, but TPB- and SCT-based studies demonstrated less consistent choices of measurement. Researchers in most studies did not test the relationships between the proposed theoretical constructs and breastfeeding outcomes as guided by theories. Inconsistent outcomes resulted among the studies due to variations in study follow-ups.

CONCLUSION

Sound applications of single or multiple theories demonstrate a great potential to help practitioners and researchers develop effective breastfeeding interventions and evaluate true impacts on positive breastfeeding outcomes.

Factors associated with Maternal Attachment of Breastfeeding Mothers

Purpose

Methods

Results

Conclusion

Drugs in lactation

Although most medications can be taken safely during breastfeeding, potential risks of infant toxicity do exist because all medications will be excreted into the breast milk to some extent. The amount of medication excreted in the milk depends mainly on (i) within-drug variation, such as dosing; (ii) between-drug variation including chemical characteristics of the medication; and (iii) host factors, such as maternal pharmacokinetics (PK), including variations of pregnancy-associated changes and their post-partum recovery. Neonatal drug exposure is usually assessed by calculating an expected total infant daily dose through breast milk and comparing it to the normal therapeutic dose. However, clinical PK studies in this population are challenging to conduct. Recently, research methods using population PK analyses and physiologically-based PK modeling and simulation techniques have been recognized as a complementary approach to the conventional PK studies in this field. These efforts are important for rational risk assessment balancing the toxicity risk against the benefits of human milk. Health benefits of lactation for both mother and child are significant and a decision to withhold from this should not be taken lightly. In case limited information is present, additional expertise from pharmacists or clinical pharmacologist with expertise in this area should be sought.