Breastfeeding support and opiate dependence: A think aloud study

Breastfeeding Experiences in Women from Ten States Reporting Opioid Use Before or During Pregnancy: PRAMS, Phase 8

INTRODUCTION

Evidence of opioid use at hospital delivery has increased over the past two decades, increasing risk of neonatal withdrawal. Breastfeeding may improve infant outcomes, but little is known about breastfeeding experiences of women who have a history of opioid use prior to or during pregnancy. This study aimed to determine if self-reported opioid use prior to or during pregnancy impacted breastfeeding, specifically attempt to breastfeed, duration of breastfeeding, assessment of prenatal breastfeeding intention, source of breastfeeding information, and early hospital experiences.

METHODS

Data from ten states (n = 10,550) that evaluated opioid use in the 2016 Pregnancy Risk Assessment Monitoring System survey were included. Weighted univariate and multivariate linear and logistic regression were calculated. The multivariate regression also included adjustment for covariates.

RESULTS

Among the overall sample, 939 participants reported opioid exposure before or during pregnancy. We found no significant difference in breastfeeding attempt. Breastfeeding for at least 6, 10, or 20 weeks was significantly less likely in participants reporting opioid exposure. Exposure correlated with lower odds of skin-to-skin contact, infant being fed in the first hour, exclusive breastfeeding in the hospital, and feeding on demand. Hospital pacifier use was associated with opioid exposure.

CONCLUSION

While we found no difference in breastfeeding attempt, we did observe significant differences in breastfeeding duration and early hospital experiences which may represent modifiable gaps in clinical practice. Future work should focus on optimizing early hospital experiences and support when breastfeeding is clinically indicated.

Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy

OBJECTIVE

To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes.

DATA SOURCES

We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid.

STUDY SELECTION

We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review.

DATA EXTRACTION

We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT.

DATA SYNTHESIS

We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors.

CONCLUSION

The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.

Systematic mixed-study review of nonpharmacological management of neonatal abstinence syndrome

BACKGROUND

Neonatal abstinence syndrome is a multisystem disorder resulting from exposure to maternal addictive substance use in pregnancy. Withdrawal is characterized by neonatal tremors, feeding difficulties, and sleep disruption. The aim of this systematic review is to explore the nonpharmacological management of infants at risk of neonatal abstinence syndrome after prenatal exposure.

METHODS

A systematic mixed-study review was conducted. A search of CINAHL, MEDLINE, AMED, PsycARTICLES, PsycINFO, and Web of Science was performed for relevant articles published between January 2007 and June 2018. Quantitative and qualitative data were extracted and thematic analysis undertaken. The findings were synthesized as a narrative summary.

RESULTS

Fourteen studies were included in the review, of which nine were quality improvement initiatives and five explored complementary therapies. The most common components of nonpharmacological management were consolation therapy and rooming-in of mother and baby. Implementation strategies incorporated family integrated care and practitioner training in the evaluation of neonatal withdrawal. When nonpharmacological management was applied, there was a reduction in the need for pharmacotherapy and a shorter hospital stay for newborns. Potential barriers to effective management included unreliable assessment tools, judgmental practitioner attitudes, and limited breastfeeding promotion.

CONCLUSIONS

Providing and optimizing nonpharmacological management for the infant at risk of neonatal abstinence syndrome improves outcomes by reducing their length of hospital stay and the need for pharmacotherapy.

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

INTRODUCTION

Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations.

METHODS

CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy.

RESULTS

Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers.

DISCUSSION

Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population.

Resources Lack as Food Environments Become More Rural: Development and Implementation of an Infant Feeding Resource Tool (InFeed)

Evaluating the availability and affordability of breastfeeding and formula-feeding supplies are critical for building food environments that support healthy infant development. This study details the development and implementation of the Infant Feeding Resource Tool (InFeed) in retail settings across Montana (n = 21). Interrater reliability was tested (n = 9), kappa 0.620. Analysis of variance found significant differences by rurality for InFeed scores, with infant feeding resources lacking in more rural Montana retail settings: Formula, p = .05 (rounded value); Equipment, p = .02; and Total, p = .03. Prices of infant feeding resources did not differ by rurality and InFeed scores did not differ by store type.

Breastfeeding and the substance-exposed mother and baby

BACKGROUND

Breastfeeding rates are typically low for women with a substance-use disorder. This is despite the specific benefits of breastfeeding to alleviate the severity of neonatal abstinence syndrome and the well-documented generic advantages. This study explored the feasibility of in-hospital, tailored breastfeeding support for the substance-exposed mother and baby.

METHODS

This was a mixed-methods feasibility study undertaken in Scotland from April 2014 to May 2015. Women with a substance-use disorder either received standard Baby-Friendly Initiative care only or were given additional support which included a dedicated breastfeeding support worker, personalized capacity-building approach, and a low-stimuli environment for 5 days. Feasibility outcome measures were maternal recruitment, satisfaction and acceptability of support, breastfeeding on fifth postnatal day, and severity of neonatal abstinence syndrome.

RESULTS

Fourteen mother-infant dyads participated. Intervention participants demonstrated higher rates of continued breastfeeding and reported a greater degree of satisfaction with support and confidence in their breastfeeding ability. Maternal experience of health care practices, attitudes, and postnatal environment influenced their perceptions of breastfeeding support. Breastfed infants were less likely to require pharmacotherapy for neonatal withdrawal and had a shorter hospital stay.

CONCLUSIONS

The findings highlight the feasibility of tailored breastfeeding support for the substance-exposed mother and baby and endorse the promotion and support of breastfeeding for this group. Future research should include a statistically powered randomized controlled trial to evaluate clinical efficacy.

Grandmother and health care professional breastfeeding perspectives provide opportunities for health promotion in an American Indian community

RATIONALE

While breastfeeding is well recognized as beneficial, rates of breastfeeding among American Indian women are below average and contribute to health inequities. Culturally specific approaches to breastfeeding research are called for to inform appropriate interventions in American Indian communities. Specifically, a grandmother's role in breastfeeding promotion is of great import particularly in American Indian (AI) groups, although is an understudied topic to date.

OBJECTIVE

This research seeks to fill a prominent literature gap by utilizing a grounded theory and community-based research approach to inform breastfeeding practices from the voices of grandmothers and health care professionals in a rural AI community in the United States.

METHODS

A community-based approach guided the research process. Convenience and snowball sampling was used to recruit for semi-structured and follow up member checking interviews with AI grandmothers (n = 27) and health care professionals (n = 7). Qualitative data were transcribed, characterized into meaning units, and coded by a review panel. Data were reconciled for discrepancies among reviewers, organized thematically, and used to generate community-specific breastfeeding constructs.

RESULTS

Three major themes emerged, each with relevant subthemes: (1) importance of breastfeeding; (2) attachment, bonding, and passing on knowledge; and (3) overburdened health care system. Multiple subthemes represent stressors and impact breastfeeding knowledge, translation, and practice within this community including formula beliefs, historical traumas, societal pressures, mistrust, and substance abuse.

CONCLUSIONS

Interventions designed to raise breastfeeding rates in the study site community would ideally be grounded in tribal resources and involve a collaborative approach that engages the greater community, grandmothers, health care professionals, and scientific partners with varying skills. More research is needed to determine stressors and any potential impact on infant feeding practices among other AI groups. Application of the research approach presented here to other AI communities may be beneficial for understanding opportunities and challenges to breastfeeding practices.

Neonatal Abstinence Syndrome: Exploring Nurses' Attitudes, Knowledge, and Practice

BACKGROUND

As opioid abuse increases in the United States, the rate of neonatal abstinence syndrome (NAS) rises dramatically. Caring for infants with NAS and their families is a significant challenge to neonatal nurses.

PURPOSE

The purpose of this survey study was to explore attitudes and practice trends among nurses caring for infants with NAS. The study also aimed to identify any gaps in knowledge about NAS.

METHOD

An anonymous, cross-sectional survey study was conducted using a researcher-developed questionnaire. The survey questionnaire included 20 Likert-scale questions regarding nurses' attitudes, knowledge, and practice in care of infants with NAS, 1 case study with 3 questions, and 2 open-ended questions. Nurses, including advanced practice nurses and nurse leaders, were invited to participate at a regional neonatal nursing conference in the New England area.

RESULTS

A total of 54 participants responded, the majority being white, female, non-Hispanic, and bachelor's prepared. Many nurses shared concerns regarding the setting in which infants with NAS are cared for. Nurses expressed varying attitudes regarding interacting with the mothers but generally wanted to build a partnership with them. Nurses also reported a lack of standardized and consistent practice in care for infants with NAS. Three major themes were identified from open-ended questions, including environmental issues, relationship with the mother, and inconsistency in care.

IMPLICATIONS FOR PRACTICE

Further research is needed for nurses providing care to infants with NAS. Specific education programs are needed for nurses who are caring for infants with NAS.

IMPLICATIONS FOR RESEARCH

Further research is needed regarding the effects of NAS on nurses and other healthcare providers.