A two-decade perspective on mothers' experiences and feelings related to breastfeeding initiation in Sweden

Scoping Review of Women's Experiences of Breastfeeding Associated With Maternity Care in Hospitals That Implement Baby-Friendly Policies

OBJECTIVE

To explore what is currently known about women's breastfeeding experiences associated with maternity care in facilities that implement policies supported by the Baby-Friendly Hospital Initiative (BFHI).

DATA SOURCES

We used the scoping review methodology of JBI. We searched the Scopus, CINAHL, Embase, MEDLINE (Ovid), and PsycINFO databases and gray literature.

STUDY SELECTION

We considered articles published during or after 1991 in English. Inclusion criteria were based on the participant, concept, and context framework and included women who gave birth and initiated breastfeeding during or after maternity care in facilities that were certified through the BFHI, were working toward certification, or were implementing BFHI-aligned policies.

DATA EXTRACTION

We extracted the following data from each report: author(s), year/country of publication, study design, research aim, patient population/sample size, clinical setting, BFHI status, and outcomes. We further extracted relevant outcomes by using concepts from the interactive theory of breastfeeding.

DATA SYNTHESIS

We included 44 reports of studies conducted in 19 countries in the review: 27 quantitative, 9 qualitative, and 8 mixed-methods studies. We mapped the extracted data to 10 concepts from the interactive theory of breastfeeding to classify patient experiences, including dynamic interaction between mother and child; stress; time; woman's and child's biological conditions; woman's and child's perception; woman's decision-making; family and social authority; woman's body image; space; and organizational systems for the protection, promotion, and support of breastfeeding.

CONCLUSION

We found that various interrelated factors in addition to BFHI-specific policies influenced women's experiences. Based on these results, we suggest that awareness of women's personal breastfeeding experiences is crucial to delivering optimal care and developing evidence-based policies. Breastfeeding practice guidelines and policies should be developed to encompass women's experiences to enhance future inpatient breastfeeding support.

The effect of delayed umbilical cord clamping on Newborn's oxygen saturation and sucking success in primiparous pregnant

AIM

The objective of this study was to examine the effect of delayed umbilical cord clamping on the newborn's oxygen saturation and sucking success in primiparas.

METHODS

The study was conducted based on the experimental model with a control group, between March 15-November 10, 2020. The sample of the study consisted of 101 primiparous pregnant (48 primiparous with delayed cord clamping within 1-3 min and 53 primiparous with early cord clamping within 1 min) (having no high-risk pregnancy, 38-42 weeks, vaginal birth) in Turkey. The data were collected using a personal information form, the LATCH breastfeeding tool and the pulse oximetry. Statistical analyses were conducted using percentage distribution, arithmetic means, chi-square testing, and independent samples t-testing.

RESULTS

Oxygen saturation values of newborns with delayed umbilical cord clamping were higher than those of newborns with early cord clamping. The saturation was first minute 66.43 versus 74.37, fifth minute 81.90 versus 88.60, tenth minute 91.77 versus 94.50 (p < 0.05). When compared to the group with early cord clamping, oxygen saturation is higher in the first by 11.95%, in the fifth by 8.18%, and in the tenth minute by 2.97% in the group with delayed cord clamping. The LATCH breastfeeding scores were found to be higher in the group with delayed cord clamping compared to the group with early cord clamping.

CONCLUSION

It was determined that delayed cord clamping positively affected oxygen saturation values and sucking success in neonatal babies. Delayed umbilical cord clamping is an important issue that needs to be addressed in its different dimensions.

Breastfeeding as a balancing act - pregnant Swedish women's voices on breastfeeding

BACKGROUND

Breastfeeding provides health benefits to both women and children. The rationale behind an individual woman's decision to breastfeed or not can depend on several factors, either independently or in combination. The aim of the current study was to explore attitudes towards breastfeeding among pregnant women in Sweden who intend to breastfeed.

METHODS

Eleven mothers-to-be, one of whom had previous breastfeeding experience, participated in the study. The women were interviewed either by telephone or face-to-face during late pregnancy, with the aim of exploring their attitudes towards breastfeeding. A semi-structured interview-guide was used, and the transcripts of the interviews were analyzed using thematic analysis. The social ecological model of health is the theory-based framework underpinning this study. The model provides a comprehensive approach to understanding the factors that influence breastfeeding intention.

RESULTS

When interviewed during pregnancy, women described breastfeeding as a balancing act between societal norms and personal desires. The women perceived a societal pressure to breastfeed, however it was accompanied by boundaries and mixed messages. This perceived pressure was balanced by their own knowledge of breastfeeding, in particular their knowledge of other women's experience of breastfeeding. When envisioning their future breastfeeding, the women made uncertain and preliminary plans, and negotiated the benefits and drawbacks of breastfeeding. There was a wish for individual breastfeeding support and information.

CONCLUSIONS

Pregnant Swedish women perceive their future breastfeeding as a balancing act between societal norms and personal desires. These findings suggest that while discussing breastfeeding during pregnancy, it could be of interest to collect information from pregnant women on their knowledge of breastfeeding and from where they have gained this knowledge, since stories from family and friends may make them question their own capacity to breastfeed. A thorough review of the woman's experiences and attitudes of breastfeeding is important in order to offer the best evidence-based breastfeeding support.

TRIAL REGISTRATION

Ethical approval for the study was obtained from the Regional Ethical Review Board in Uppsala (Dnr: 2017/256).

Mothers' Expectations and Factors Influencing Exclusive Breastfeeding during the First 6 Months

The aims were to determine Spanish women’s expectations about exclusive breastfeeding (EB) and the effect of expectations and other factors on EB during the first 6 months. A prospective cohort study was conducted with 236 participants. Variables were maternal age, marital status, occupation, expectations about breastfeeding, knowledge about breastfeeding, type of delivery, type of feeding, and duration of EB. Data were collected through three personal interviews, at the hospital (before delivery) and in two telephone calls in the first and sixth months postpartum. Average age was 32.3 years (SD = 5.3); average duration of EB was 2.73 months (SD = 2.49). Of 236 women who had decided to breastfeed before birth, 201 (85.2%) offered EB after delivery. Achievement of expectations was most influenced by the decision to continue breastfeeding ‘as long as I can’ (OR: 5.4; CI: 2.0–14.6) and previous experience (OR: 3.2; CI: 1.2–8.5). Knowledge of breastfeeding acquired from relatives (OR: 9.2; CI: 3.0–27.9), caesarean delivery (OR: 4.6; CI: 1.7–12.8) and maternal age (36–40 years old) (OR: 7.5; CI: 1.8–30.9) were associated with failure to achieve EB. Achievement of EB may depend on a woman’s confidence in her ability to do so and on knowledge obtained in the social environment.

Milk feeding and first complementary foods during the first year of life in the TEDDY study

The aim was to describe milk feeding patterns and first weaning foods during the first year of life in a large prospective birth cohort of infants with increased genetic risk for Type 1 diabetes (T1D) recruited in 4 different countries: the United States, Finland, Germany, and Sweden. All enrolled children with dietary information (n = 8,673) were included in the analyses; 1,307 (15%) children who dropped out before the first birthday were excluded from some analyses. Supplementary milk feeding in the first 3 days of life was common in all the four countries, although the type of the supplementary milk differed by country and by maternal T1D. Donated human milk was commonly used only in Finland. In all the countries, the most common first supplementary food was cow's milk-based infant formula, especially among offspring of mothers with T1D. The use of specific types of infant formulas differed notably by country: Extensively hydrolysed formulas were most used in Finland, partially hydrolysed ones in the United States and in Germany, and soy formulas only in the United States. Infant formulas commonly included probiotics, prebiotics, and starches. During the first year of life, most of the infants received conventional cow's milk. Overall, milk feeding during the first 3 days of life and thereafter until the first birthday differed markedly by maternal T1D status and across countries. These descriptive data may be useful in understanding early infant feeding practices and in planning potential interventions, which affect infant feeding.

Improving Breastfeeding Support by Understanding Women's Perspectives and Emotional Experiences of Breastfeeding

Exclusive breastfeeding for at least 6 months is universally acknowledged as the optimal means of infant nutrition. However, current studies show that most women are not following this recommendation. Many studies address the issue of increasing breastfeeding rates, but fewer explore the perspectives and experiences of breastfeeding women. In this article we review the literature and identify common themes in women's breastfeeding experiences. Nurses and other health care providers stand to help or hinder breastfeeding women, and they must be aware of and sensitive to women's personal experiences and perspectives to understand how to best promote and support women in their attempts to meet their breastfeeding goals.

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years

OBJECTIVE

There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants.

DESIGN, SETTING AND PARTICIPANTS

This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004-2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups.

RESULTS

From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22-27 weeks) from 55% to 16%, in very preterm (GA 28-31 weeks) from 41% to 34% and in moderately preterm infants (GA 32-36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants).

CONCLUSIONS

In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.

Maternal, Infant Characteristics, Breastfeeding Techniques, and Initiation: Structural Equation Modeling Approaches

Objectives

The aim of this study was to examine the relationships among maternal and infant characteristics, breastfeeding techniques, and exclusive breastfeeding initiation in different modes of birth using structural equation modeling approaches.

Methods

We examined a hypothetical model based on integrating concepts of a breastfeeding decision-making model, a breastfeeding initiation model, and a social cognitive theory among 952 mother-infant dyads. The LATCH breastfeeding assessment tool was used to evaluate breastfeeding techniques and two infant feeding categories were used (exclusive and non-exclusive breastfeeding).

Results

Structural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation. A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation. Breastfeeding techniques were significantly positively associated with exclusive breastfeeding initiation in the entire sample and in the vaginal deliveries group. However, breastfeeding techniques were not significantly associated with exclusive breastfeeding initiation in the cesarean section group. Maternal age, maternal race, gestations, birth weight of infant, and postnatal complications had no significant impacts on breastfeeding techniques or exclusive breastfeeding initiation in our study. Overall, the models fitted the data satisfactorily (GFI = 0.979–0.987; AGFI = 0.951–0.962; IFI = 0.958–0.962; CFI = 0.955–0.960, and RMSEA = 0.029–0.034).

Conclusions

Multiparity and jaundice of an infant were found to affect breastfeeding technique and exclusive breastfeeding initiation respectively. Breastfeeding technique was related to exclusive breastfeeding initiation according to the mode of birth. This relationship implies the importance of early effective interventions among first-time mothers with jaundice infants in improving breastfeeding techniques and promoting exclusive breastfeeding initiation.