Breastfeeding Peer Support Program Increases Breastfeeding Duration Rates Among Middle- to High-Income Women

Association Between Breastfeeding Peer Support and Confidence in Breastfeeding

BACKGROUND

Peer support programs may be effective for supporting breastfeeding among diverse groups, and in reducing disparities. This study provides insight regarding the implementation and outcomes of a peer breastfeeding support program.

RESEARCH AIMS

(1) to examine how participation affected the outcomes of breastfeeding motivation, confidence, and coping strategies; and (2) to evaluate satisfaction with the program.

METHOD

This was a cross-sectional, retrospective study. Seven pilot sites in the United States uniquely implemented a federally-funded peer support program for low-income women. Data were collected using a survey and focus groups/interviews. Over 12 months, 1,296 women participated, comprising 615 peer support pairs. A total of 401 women responded to the survey. Twenty-three focus groups and 63 interviews were conducted across the seven sites.

RESULTS

Participants who enrolled in the program during pregnancy: t (189) = -6.55, p < 0.001, and after the baby was born: t (170) = -2.59, p = 0.001, gained confidence in breastfeeding. More satisfied participants were more likely to breastfeed longer: F (7,352) = 12.75, p < 0.001, and cope with breastfeeding challenges: F (7,352) = 7.83, p < 0.001.

CONCLUSION

Effective operation strategies of the peer breastfeeding support program have significantly influenced participant satisfaction. Introducing peer support for low-income women to share their breastfeeding experiences would be beneficial in enhancing breastfeeding rates. However, the generalizability of these findings may be limited to this U.S. federally-funded peer support program.

Internet-based breastfeeding peer support for breastfeeding parents: An integrative review

AIM

To explore what Internet-based breastfeeding peer support offers to breastfeeding parents.

DESIGN

Integrative review.

DATA SOURCES AND REVIEW METHODS

A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted.

RESULTS

The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices.

CONCLUSION

Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence-based and the support is encouraging.

IMPACT

These findings show that well-moderated online breastfeeding peer support can offer parents high-quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high-quality support groups for breastfeeding parents.

REPORTING METHOD

PRISMA.

PATIENT OR PUBLIC CONTRIBUTION

This was an integrative review therefore no patient or public contribution was necessary.

Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

Breastfeeding but not Exclusively: Exploration of Chinese American Mothers' Infant Feeding Practices

BACKGROUND

Previous qualitative researchers have shown that Chinese American mothers experienced high rates of suboptimal breastfeeding, especially early introduction of other foods before the recommended 6-month period of exclusive breastfeeding.

RESEARCH AIMS

(1) To explore attitudes that Chinese American mothers have about the meaning and practice of exclusive breastfeeding; (2) to evaluate the extent of family pressure and support to maintain exclusive breastfeeding; and (3) to examine the influence of breastfeeding self-efficacy and the intention to continue exclusive breastfeeding.

METHOD

Guided by the theory of planned behavior, this descriptive cross-sectional prospective online survey was conducted with Chinese American breastfeeding mothers (N = 401). Participants' attitudes, subjective norms, and perceived behavioral control for exclusive breastfeeding behaviors were measured.

RESULTS

The M (SD) age of participants was 29.14 (SD = 6.90). Just over 50% reported receiving family support for exclusive breastfeeding. While participants had positive attitudes about exclusive breastfeeding and the value of colostrum, 64% (n = 257) had already introduced foods other than mother's own milk before their infant was 6-months old. Participants also expressed concern that their infants did not receive enough nutrition from exclusive mother's milk. Participants with more than one child had significantly greater intention to continue exclusive breastfeeding compared to participants with only one child. Perception of approval by others for exclusive breastfeeding and breastfeeding self-efficacy were significantly related to behavioral intention to continue exclusive breastfeeding.

CONCLUSION

Suboptimal infant feeding is a problem for Chinese American women and may also be a problem for mothers in other ethnic groups. We found a lack of adherence with standard recommendations for sustaining 6-months of exclusive breastfeeding.

Feasibility, acceptability, and potential efficacy of an innovative postnatal home-based breastfeeding peer support programme in Hong Kong: a feasibility and pilot randomised controlled trial

BACKGROUND

As suggested by the World Health Organization, breastfeeding peer support is being introduced worldwide to support women's breastfeeding needs. Evidence has shown that when such support is offered to women, the duration and exclusivity of breastfeeding is increased. We developed an innovative home-based intervention to sustain exclusive breastfeeding in Hong Kong. However, potential barriers must be addressed before a full randomised controlled trial (RCT) is conducted. The aim of this study was to determine the feasibility of a breastfeeding support programme with home-based visits from peer supporters over a six month period among postpartum Chinese women in Hong Kong.

METHODS

We conducted a feasibility and pilot randomised controlled trial. Twenty primiparous women intending to breastfeed their healthy term singleton infant were recruited from a hospital in Kowloon, Hong Kong between February and March 2019. Participants were randomly allocated to the intervention or control group. Participants in the intervention group received five home-based visits with a peer supporter over a six month period, as well as standard care, whereas participants in the control group received standard care only. We assessed feasibility, compliance, and acceptability of the breastfeeding peer support programme. Other outcomes assessed were breastfeeding self-efficacy, duration, and exclusivity.

RESULTS

It was feasible to recruit and train existing peer supporters, and peer supporters were able to deliver the intervention, which was acceptable to women, but rates of stopping the intervention and loss to follow-up were high. There was higher retention seen within the first month. Women interviewed at the end of the study reported that the intervention was positive. The cessation risk of any, and exclusive breastfeeding were not statistically different between the intervention and control groups.

CONCLUSIONS

This study provided valuable information on feasibility of the trial design and intervention. Modifications to the intervention, such as targeting women with lower breastfeeding self-efficacy, or combining home visits with technology and telephone follow-up may be more appropriate in a larger trial. Implementing the programme early during the antenatal phase and tailoring peer support to most appropriately sustain exclusive breastfeeding and other feeding modes should be incorporated in a future home-based peer support arm.

TRIAL REGISTRATION

NCT03705494 on 15 Oct 2018.

What is the impact of rural-to-urban migration on exclusive breastfeeding: a population-based cross-sectional study

Background

In China, less than one third of infants under 6 months of age are being exclusively breastfed. Maternal rural-to-urban migration contributes to these low rates of breastfeeding practices. Therefore, the aim of this study was to assess the prevalence of breastfeeding practices and associated factors among rural-to-urban migrant children and local children with infants aged 0–12 months in China, 2018.

Methods

Data were collected from a population-based cross-sectional survey in 2018 that included 6995 infants from eight urban areas (four metropolis and four medium sized/small cities) in China. The prevalence of breastfeeding practices was calculated using a 24-h recall questionnaire for all infants aged under 12 months. Logistic regression was conducted to examine the association between the prevalence of breastfeeding practices and maternal migrant status, after adjusting for sociodemographic characteristics, mother-infant health information and supportive information. For exclusive breastfeeding, we further analyzed its association with maternal rural-to-urban migration, stratified by maternal education level, maternal resident place and maternal ethnicity, respectively.

Results

The overall prevalence of ever breastfeeding, exclusive breastfeeding, predominant breastfeeding and age-appropriate breastfeeding (exclusive breastfeeding of infants under 6 months of age and complementary feeding from six to 12 months of age) was 97.51, 29.84, 59.89 and 45.07%, respectively. Rural-to-urban migrant children were less likely to be exclusively breastfed compared to local children (AOR 0.81, 95% CI 0.68, 0.95). Stratified by different sociodemographic variables, a negative association between exclusive breastfeeding and rural-to-urban migration was only found in the group with high education level, in the group living in metropolis and in the group of minorities, respectively.

Conclusions

The overall prevalence of breastfeeding practices was low in both rural-to-urban migrant children and local children. Besides common strategies, special approaches should be provided for urban highly educated migrants.

Changes in individual and contextual socio-economic level influence on reproductive behavior in Spanish women in the MCC-Spain study

Background

The association between socioeconomic level and reproductive factors has been widely studied. For example, it is well known that women with lower socioeconomic status (SES) tend to have more children, the age at first-born being earlier. However, less is known about to what extent the great socioeconomic changes occurred in a country (Spain) could modify women reproductive factors. The main purpose of this article is to analyze the influence of individual and contextual socioeconomic levels on reproductive factors in Spanish women, and to explore whether this influence has changed over the last decades.

Methods

We performed a cross-sectional design using data from 2038 women recruited as population-based controls in an MCC-Spain case-control study.

Results

Higher parent’s economic level, education level, occupational level and lower urban vulnerability were associated with higher age at first delivery and lower number of pregnancies. These associations were stronger for women born after 1950: women with unfinished primary education had their first delivery 6 years before women with high education if they were born after 1950 (23.4 vs. 29.8 years) but only 3 years before if they were born before 1950 (25.7 vs. 28.0 years). For women born after 1950, the number of pregnancies dropped from 2.1 (unfinished primary school) to 1.7 (high education), whereas it remained almost unchanged in women born before 1950.

Conclusions

Reproductive behavior was associated with both individual and area-level socio-economic indicators. Such association was stronger for women born after 1950 regarding age at first delivery and number of pregnancies and for women born before 1950 regarding consumption of hormonal contraceptives or postmenopausal therapy.

Breastfeeding: uncovering barriers and offering solutions

PURPOSE OF REVIEW

The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months after an infant is born. Although the recommendations are well known, mothers face barriers that make breastfeeding difficult. This article reviews the recent literature on barriers to breastfeeding as well as strategies for pediatricians to use to help women overcome them.

RECENT FINDINGS

The mode of delivery, mother's socioeconomic status, return to work, and prenatal breastfeeding education have been reported as factors that influence breastfeeding. Family-centered models for breastfeeding, peer support groups, and technology have been studied as potential ways to help women meet their breastfeeding goals.

SUMMARY

Pediatricians are the first providers to care for babies after hospital discharge and are likely the first doctors that mothers see after childbirth. These early visits create opportunities for pediatricians to learn about the barriers that their patients face and open the doors to addressing these barriers.