New Mothers' Perceptions of Pressure to Breastfeed

Breastfeeding Counseling Practices Among Plastic Surgeons: Results From a National Survey

Background

Breastfeeding has well-established benefits for maternal and infant health. Difficulty with breastfeeding is a possible complication after breast surgery and can have detrimental maternal psychological consequences. Although lactation outcomes after breast surgery have been reported, plastic surgeons' preoperative counseling practices regarding breastfeeding after surgery have not yet been studied.

Methods

From November 2021 to January 2022, a 25-question anonymous survey on breastfeeding counseling practices, personal breastfeeding experiences, demographics, surgical training, and length of practice was administered to 6000 members of the American Society of Plastic Surgeons.

Results

A total of 146 respondents were included, and 90.7% of respondents believe that breast surgery can affect breastfeeding. Although 96.6% of respondents routinely discuss possible postoperative challenges with breastfeeding, 39.3% differentiate between inclusive and exclusive breastfeeding, 22.2% discuss potential emotional consequences, and only 12.8% discuss the need for galactagogues or labor-intensive ancillary activities. Significantly more respondents who had been in practice for less than 15 years believed that breast surgery can affect breastfeeding and reported counseling on breastfeeding impairment risk before transgender top surgery, compared with those who had been out of training for more than 15 years (96% versus 84%, P = 0.05; 72% versus 54%, P = 0.05).

Conclusions

Most plastic surgeons believe breast surgery can affect lactation and counsel patients as such. However, the potential deleterious mental health consequences of challenged breastfeeding after breast surgery seem undercounseled. Our findings highlight a potential need for increased education and improved preoperative breastfeeding counseling protocols for plastic surgeons.

Psychosocial Factors Influencing Breastmilk Production in Mothers After Preterm Birth: The Role of Social Support in Early Lactation Success-A Cross-Sectional Study

BACKGROUND

Preterm birth is a major global health issue, associated with increased neonatal morbidity and mortality. Mothers of preterm infants face unique challenges, particularly with regard to lactation, due to the complexities of preterm neonatal care. Social support has been recognized as a factor in promoting successful breastfeeding, especially in vulnerable groups such as mothers of preterm infants.

OBJECTIVE

This study aimed to explore the psychosocial factors influencing breastfeeding in mothers following preterm birth, with a particular focus on the role of social support in early lactation success.

METHODS

A cross-sectional observational study was conducted between December 2022 and March 2023 at a tertiary referral hospital in Poland. The study included 130 women (71 mothers of preterm infants and 59 mothers of full-term infants) in the early postpartum period. Data were collected through a self-administered questionnaire and the Polish version of the Berlin Social Support Scales (BSSS). Lactation success was assessed based on the mother's ability to initiate and maintain breastfeeding or expressed milk production. Statistical analyses included Mann-Whitney U tests, Pearson's Chi-Square, and logistic regression to determine the association between social support and lactation outcomes.

RESULTS

The study revealed that mothers of preterm infants exhibited a greater need for social support compared with those who delivered at term. Social support, particularly perceived emotional and practical support, appeared to be significantly associated with successful early lactation. Women who received adequate social support were more likely to initiate breastfeeding early and maintain lactation.

CONCLUSIONS

Psychosocial factors, particularly social support, play a critical role in the success of lactation among mothers of preterm infants. These findings underscore the need for comprehensive support systems for mothers of preterm infants to promote breastfeeding and improve neonatal health outcomes.

Infant and early childhood physical health assessments in the HEALthy Brain and Child Development (HBCD) Study

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social and emotional development beginning prenatally and planned through early childhood. Many prenatal and early childhood exposures impact both later physical health and development. Moreover, early deficits in physical health, such as growth and vision, are associated with differences in brain development, language and cognitive functioning. For these reasons, the HBCD Study includes measures of early childhood physical health, many of which have clinical relevance, and are applicable for use as both predictors and outcomes. Study measures assess a broad range of physical health domains and include both objective measurement of child growth and health and subjective caregiver report of behaviors and attitudes about constructs known to influence growth and physical development. Lastly, we obtain caregiver report of the child's routine medical care as well as acute and chronic medical issues. We anticipate that these data will contextualize the impact of child physical growth and health on child brain development and function. In this report we present the rationale for each domain and an overview of the physical health measures included in the current HBCD Study protocol.

Importance Assigned to Breastfeeding by Spanish Pregnant Women and Associated Factors: A Survey-Based Multivariate Linear Correlation Study

Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women's decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother's health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding.

[Letter to the Editor Concerning "Prevalence and Predictive Factors of Exclusive Breastfeeding in the First Six Months of Life"]

N/a.

Pressure to provide milk among mothers of very low birth weight infants: an explorative study

BACKGROUND

Pump-dependent mothers of very low birth weight (VLBW, < 1500g) infants experience specific challenges achieving sufficient milk supply in the neonatal intensive care unit (NICU) and are therefore less frequently able to achieve (exclusive) breast milk feeding. Stress due to the limitations on participating in the infant's care may contribute to this problem. Some explorative studies suggest that pressure to provide milk may be an additional stressor in mothers. However, the type of pressure to provide milk perceived by mothers of VLBW infants has rarely been examined.

METHODS

A retrospective and anonymous questionnaire was conducted with mothers of VLBW infants aged 6 to 24 months at the time of data collection. Quantitative data and written comments were used to examine the mothers' perceptions. Descriptive and bivariate tests (Spearman´s rho, Pearson's chi2) were performed to show correlations between pressure to provide breast milk, parental stress (PSS:NICU: role alteration subscale), milk volume, and maternal factors. Pressure to provide milk was measured through two self-developed single items to differentiate between internal and external pressures.

RESULTS

Data of n = 533 mothers of VLBW infants was analysed. More than 70% of the mothers agreed that they pressured themselves to provide milk for their infant. In contrast, 34% of the mothers agreed that they felt pressure from outside to provide milk. Higher milk volume 14 days post-partum was significantly correlated with higher internal (Spearman´s rho = 0.2017, p = 0.000) and higher external pressure to provide milk (Spearman´s rho = 0.2991; p = 0.000). Higher PSS:NICU parental role alteration scores were significantly correlated with more internal (Spearman´s rho = -0.2865, p = 0.000) and more external pressure to provide milk (Spearman´s rho = -0.1478; p = 0.002). Milk volume 14 days post-partum and the PSS:NICU were not significantly correlated (Spearman´s rho = -0.0190; p = 0.701). Qualitative analyses highlighted these results and enhanced the bidirectional relationships between maternal pressure to provide milk and milk volume.

CONCLUSIONS

Especially internal pressure to provide milk is perceived by many mothers, being mutually dependent on milk supply and parental stress. Pressure to provide milk may be an important factor to decrease maternal stress in the NICU and, therefore, lead to more positive pumping and breastfeeding experiences. More research and validated instruments are needed to adequately measure pressure to provide milk with its different psychological, social, and environmental dimensions.

Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.

The Challenges of Parenthood for Female Surgeons: The Current Landscape and Future Directions

Although surgical training programs have nearly reached gender parity, pregnancy and parenthood remain challenging for female surgeons, with obstetric risks related to occupational demands, stigma, inconsistent and brief parental leaves, a paucity of postpartum support for lactation and childcare, and little mentorship on work-family integration. This work environment causes many to postpone starting a family, which leads to higher risks of infertility among female surgeons compared to their male peers. Perception of work-family incompatibility jeopardizes recruitment and retention of our surgical workforce, as it deters medical students from the profession, increases risk of resident attrition, and leads to burnout and career dissatisfaction. The challenges of parenthood for female surgeons was the focus of a Hot Topics session during the 2022 Academic Surgical Congress, the discussion of which is presented herein with recommendations for policy change to better support maternal-fetal health and the needs of surgeons with young children.

Perceptions of Mothers about Support and Self-Efficacy in Breastfeeding: A Qualitative Study

Breastfeeding is a complex process influenced by different personal and social factors which will determine both the initiation and the resilience for its maintenance. The aim is to identify the beliefs and expectations of mothers concerning breastfeeding to determine the perception of their self-efficacy and the influence on the management of their babies' feeding. A qualitative study through semi-structured interviews was carried out. The sample size was defined by the saturation criteria. Twenty-two women participated, eleven were from an urban environment and eleven were from a rural environment. Mothers' knowledge of breastfeeding, their expectations of that process, their experience, and their strategies for overcoming problems associated with initiating, establishing, and continuing breastfeeding were influenced by the role of nurses and midwives in supporting their perception of self-efficacy. Likewise, maternity policies are important for the continuance of exclusive breastfeeding. This study shows the complexity of the initiation and establishment of breastfeeding and the existence of several social factors surrounding these moments. Furthermore, it demonstrates the importance and reference of nurses and midwives and the role of State maternity policies.