Predictors of the duration of breastfeeding in low-income women

Intention or Experience? Predictors of Continued Breastfeeding

Despite the known benefits of breastfeeding, many women do not breastfeed their infants or stop breastfeeding early. This study examines the effects of prenatal intention and initial breastfeeding experiences on breast-feeding initiation and duration among 1,665 U.S. women completing questionnaires on infant feeding practices. Outcomes included no initiation of breastfeeding at birth and termination at < 10 weeks, 10 to < 20 weeks, or 20 to < 30 weeks. Predictor variables included intended breast feeding duration and early breast feeding experiences with analyses controlling for demographic characteristics, previous breastfeeding experience, and prenatal intentions to work after delivery. Prenatal intentions to never initiate or to stop breastfeeding early were significant risk factors for all breastfeeding outcomes. Initial breastfeeding experiences were significant risk factors for early termination. This study supports using the intention construct from the theory of reasoned action to predict initiation of behavior but suggests the need to include initial experience when predicting maintenance of behavior.

A meta-ethnographic synthesis of women's experience of breastfeeding

Despite considerable evidence and effort, breastfeeding duration rates in resource-rich countries such as Australia remain below World Health Organization recommendations. The literature on the experience of breastfeeding indicates that women construct and experience breastfeeding differently depending upon their own personal circumstances and the culture within which they live. Breastfeeding has also been described as a deeply personal experience, which can be associated with 'moral' decision-making. The aim of this synthesis was to better understand the social phenomenon of breastfeeding by making the hidden obvious. Using a meta-ethnographic approach, we analysed the findings from 17 qualitative studies exploring women's experience of breastfeeding. Commonly used metaphors, ideas and phrases across the national and international qualitative studies were identified. Two overarching themes emerged. Breastfeeding was described in terms of 'expectation' and 'reality', while the emotional aspects of breastfeeding were expressed in 'connected' or 'disconnected' terms. The prevalence of health professionals and public health discourses in the language women use to describe their experience, and the subsequent impact of this on maternal confidence and self-assessment of breastfeeding are discussed. This synthesis provides insight into some of the subtle ways health professionals can build maternal confidence and improve the experience of early mothering.

Breastfeeding attitudes and reported problems in a national sample of WIC participants

Recent reports indicate that breastfeeding rates continue to be dramatically lower among WIC participants, compared with other US mothers. The WIC Infant Feeding Practices Study was a nationally representative 1-year longitudinal study of WIC participants that obtained information about attitudes regarding infant feeding and about infant-feeding practices. Hispanic mothers were most likely to agree with statements about benefits of breastfeeding, and Black mothers were most likely to agree with statements about barriers. Concern about insufficient milk was common in all ethnic groups. Perceived benefits were associated with breastfeeding initiation (P < .05), longer breastfeeding duration (P < .01), and later formula initiation (P < .01); for barriers, the opposite pattern was found. Breastfeeding mothers who reported concern about insufficient milk breastfed for shorter durations (P < .001) and initiated formula earlier (P < .01). These results suggest possible messages that should be communicated as part of a re-energized WIC breastfeeding promotion campaign. In particular, maternal anxiety about insufficient breast milk must be addressed.

A psychometric assessment of the H & H Lactation scale in a sample of thai mothers using a repeated measurement design

BACKGROUND

The H & H Lactation (H & H) scale is a useful instrument for understanding mothers' perceptions of insufficient milk supply, which is the common reason given for premature cessation of breastfeeding. This instrument may be used to intervene in postbirth dropoff in breastfeeding among mothers.

OBJECTIVES

To examine construct and nomological validity and related psychometric evidence for the translated H & H scale using a repeated measurement design in a sample of Thai mothers.

METHOD

A repeated measurement design with 196 mother-infant dyads. Data were collected at two time periods. At Time 1, data on the H & H and Index of Breastfeeding Status (IBS) scales were obtained between 36 and 48 hr postbirth. For Time 2, the same mothers completed the same instruments at 1 month postbirth. Psychometricproperties of the H & H scale were examined using convergent, discriminant, and nomological validity principles with instructural equation modeling.

RESULTS

Based on judgment/classification task, exploratory/confirmatory factor analysis, and cross-validation using multisample analysis, only nine items of the H & H scale measured at Time 1 and Time 2 were found to be psychometrically sound for measuring insufficient milk supply for Thai mothers. An analysis of the influence of the nine-item of the H & H scale measured at Time 1 and Time 2 on the IBS measured at Time 2 showed that (a) the direct effects of two subscales of the H & H scale measured at Time 2 on the IBS were significant and positive, providing support for the nomological validity of the H & H scale; (b) each H& H factor at Time 1 had a significant influence on its corresponding factor at Time 2, supporting convergent validity; and (c) the crossover effects for each H & H factor for Time 1 and Time 2 data were nonsignificant, indicating discriminant validity.

DISCUSSION

Overall, the 20-item H & H scale appears to be unreliable and invalid for measuring the concept of insufficient milk supply in cross-cultural studies. However, the short form of nine items is reliable and valid for Thai mothers. Further testing and development of the H & H scale and the proposed short form in other cultures and contexts is warranted.

Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions?

BACKGROUND

In the United States, since a substantial percentage of mothers are not breastfeeding, research is needed to assess important influences on breastfeeding. The current study assessed the impact on breastfeeding of the perceived attitudes of health care providers about infant feeding.

METHODS

A longitudinal mail survey (1993-1994) was administered to 1620 women prenatally through 12 months postpartum; the current study focused on the prenatal and neonatal periods (66% response rate). The outcome variable was failure to breastfeed beyond 6 weeks. Predictor variables were the mother's perceptions of her prenatal physician's and hospital staff's attitudes on infant feeding. Analysis controlled for mother's prenatal breastfeeding intentions, father's feeding preference, and demographic and psychosocial variables.

RESULTS

Forty-one percent of the mothers were not breastfeeding at 6 weeks postpartum. Substantial percentages of mothers reported that physicians and hospital staff expressed a preference for breastfeeding (38% and 57%, respectively), or expressed no preference (61% and 42%, respectively), whereas few favored formula feeding. Adjusted analyses indicated that "no preference" by hospital staff was a significant risk factor for failure to breastfeed beyond 6 weeks. "No preference" by physicians did not significantly influence breastfeeding outcome in these analyses. Further analyses indicated that the effects of perceived hospital staff attitudes were only present for mothers who intended prenatally to breastfeed for 2 months or less.

CONCLUSIONS

Many women did not report receiving positive breastfeeding messages from their health caregivers and hospital staff. A perceived neutral attitude from the hospital staff is related to not breastfeeding beyond 6 weeks, especially among mothers who prenatally intended to breastfeed for only a short time.

Explaining infant feeding style of low-income black women

Unstructured interviews were conducted with 10 low-income black women to explore infant feeding style. Formula-feeding with early introduction of cereal in the bottle was the most common pattern used by mothers in the first 3 months. By 6 months, formula-fed infants had a complex diet of a variety of foods. Half the women intended to breast-feed, but only one exclusively breast-fed. Beliefs about healthy infants and crying influenced feeding. There was a lack of knowledge about and support for breast-feeding in these women's environment. Support and advice about infant feeding from the health care system were uneven.

Breastfeeding and health professional encouragement

The objective of the study was to ascertain the nature of health professional contacts related to breastfeeding for 341 women. Subjects were prospectively queried by phone or home visit over a 20-week period regarding the number and nature of contacts with health care professionals related to breastfeeding. Lactation consultants gave significantly more positive encouragement (98%) (p = .01) than either nurses (75%) or physicians (68%) did. However, of the 233 health provider contacts that included breastfeeding advice, only 21% involved lactation consultants. Primiparae were likely to decrease their level of breastfeeding if a health professional encouraged supplemental foods (39%) or weaning (86%) during the prior week. Multiparae who were experienced at breastfeeding (3+ weeks breastfeeding the previous infant) decreased their breastfeeding slowly across the weeks with the current infant, and their level of breastfeeding in general appeared independent of health care provider advice. Multiparae who lacked previous sustained breastfeeding experience (0-3 weeks) had the most rapid decrease (65%) in their breastfeeding rates even with health care provider encouragement to continue. Thus, they too appeared to act independently of health care provider advice.

[Factors influencing the duration of breast feeding. A study of 150 women]

BACKGROUND

The duration of breast feeding has not yet been thoroughly described in France. A prospective survey has been performed on 150 breast feeding mothers to determine its duration. The objective of this study was to analyse predicting factors of this duration.

METHODS

A questionnaire including sociological, psychological and medical variables was completed by the mothers and fathers. After discharge, the mothers were contacted every month by a physician until the completion of weaning.

RESULTS

The median duration was 10 weeks. By univariate analysis, several variables were associated with a longer duration: decision to breast feed before pregnancy (12 weeks vs 9 weeks; P < 0.01), multiparity (17 weeks vs 12 weeks, P < 0.05), high paternal social level (14 weeks vs 9 weeks, P < 0.001), high maternal education level (12 weeks vs 9 weeks; P < 0.05), mother's idea of "bad" milk (9 weeks vs 30 weeks; P < 10(-6), satisfied mothers (11 weeks vs 2 weeks; P < 0.001), motivation to breast feed (P < 0.05), baby and mother in the same room during the night (13 weeks vs 10 weeks; P < 0.05), and formula supplementation (6 weeks vs 13 weeks; P < 0.01). The mother's return to work was related to a decline in the breast feeding rate at 12 weeks, yet working women generally breast fed the most frequently before returning to work, and many women breast fed and worked concomitantly. A Cox multivariate analysis took into account six significant variables: "bad" milk (lower duration), mother who had been fed, mother satisfied with breast feeding, multiparity, high maternal education, closer proximity of baby to mother (longer duration).

DISCUSSION

The duration in our study is longer than in other studies in France. Predictive factors are sociological, linked to maternal education, and psychological, with antecedent of mother breast feeding and decision before pregnancy. The role of the mother's occupation was not very important because working women are generally at a higher social level. The role of the father was analysed, as well as the role of professional workers, family and breast feeding women's associations.

CONCLUSION

Factors of breast feeding duration can be somewhat modified, but it is necessary to respect the plans of both the mother and the father. However, early assistance in the hospital and after discharge can help parents realize their plans for prolonged breast feeding and helps obviating the cessation of 20% of mothers during the 1st month.

Effects of parity and weaning practices on breastfeeding duration

The purpose of this project was to examine (a) patterns of breastfeeding and (b) duration with parity and breastfeeding experience, and (c) mothers' reasons for termination of breastfeeding. A convenience sample of 120 breastfeeding mothers was followed by home visits and telephone for 20 weeks after delivery. The sample consisted of 69 primiparas, 40 multiparas with previous breastfeeding experience, and 11 multiparas with no prior breastfeeding experience. Parity was not significantly associated with the continuation of breastfeeding but there was a trend toward a difference made by breastfeeding experience. Inadequate milk supply and employment were the two most common reasons reported for weaning. Implications for support in the workplace and for first-time breastfeeding mothers are discussed.

Does early supplementation affect long-term breastfeeding?

The purpose of this secondary data analysis from two different samples was to examine the effect of early supplementation with manufactured milks on breastfeeding status at 20 weeks postpartum in mothers of healthy term infants. In two convenience samples of 120 and 223, respectively, breastfeeding mothers were followed up for 20 weeks postpartum or until weaning occurred. The breastfeeding rate at 20 weeks postpartum was significantly greater for mothers who reported feeding exclusively mother's milk the second week after delivery compared with mothers who breastfed and simultaneously supplemented with manufactured infant milks. Of the mothers in samples one and two who exclusively fed human milk during week 2 postpartum, 63.0% and 59.7%, respectively, were still breastfeeding at week 20, compared with 28.1% and 24.2%, respectively, who supplemented with artificial milks. There was no significant difference between these two groups of mothers and their intended duration of breastfeeding. Early introduction of supplemental bottles of artificial milks is associated with a decrease in the amount of human milk the infant receives as well as with early weaning.

Support of breastfeeding through telephone counseling in Korea

This study analyzed the problems of breastfeeding mothers who used a telephone consultant for advice. In one South Korean metropolitan area, 92 breastfeeding mothers received telephone consultation between August 24, 1994 and June 30, 1995. Mothers learned about the availability of the consultant from UNICEF, hospitals, and the general media. Problems were grouped into 11 categories (and 22 nursing diagnoses) the most common of which was breast milk insufficiency (22 cases). Fourteen mothers sought consultation about their infants' diarrhea or frequent stools. The findings in this study have practical implications for breastfeeding promotion and education in Korea.

Criteria for successful breastfeeding: mothers' perceptions

A descriptive study was conducted to determine the criteria Western Australian mothers use to decide whether their breastfeeding was successful. Successful breastfeeding tends to be measured by duration with minimal research examining breastfeeding success from mothers' perspectives. Telephone interviews were conducted with 183 mothers who were asked to classify their breastfeeding as successful or unsuccessful and identify criteria used as a basis for their decision. Nineteen women (10 unsuccessful, 9 successful) were then interviewed in depth. Content analysis revealed breastfeeding success or failure to be a personally defined experience. Four categories of criteria used to determine breastfeeding success emerged: giving, persistence, meeting expectations and accomplishing personal goals. Nurses play a significant role in promoting breastfeeding. Therefore, encouraging understanding of the mother's perspective values the uniqueness of each experience and allows nurses to assess, acknowledge and reinforce a mother's perceptions of success.

Breastfeeding preterm twins: a case report

This case report describes a primipara who successfully breastfed 35-week-gestation twins for over six months. Positive interactions, research-based management strategies, and innovative problem solving helped her avoid the individual, interpersonal, and system factors that can influence lactation failure.

Maternal perceptions of successful breastfeeding

Twenty-six mothers were interviewed concerning successful and unsuccessful breastfeeding. Constant comparative analysis yielded five major categories of successful breastfeeding: infant health, infant satisfaction, maternal enjoyment, desired maternal role attainment, and lifestyle compatibility. A core concept, working in harmony, emerged as a unifying theme. Mothers described successful breastfeeding as a complex interactive process resulting in mutual satisfaction of maternal and infant needs. This concept broadens definitions of successful breastfeeding often used by health professionals, which emphasize breastfeeding duration and nutritional aspects.

The development of the Maternal Breastfeeding Evaluation Scale

A Maternal Breastfeeding Evaluation Scale was developed from categories identified in qualitative research. Content validity was tested according to procedures described by Imle and Atwood and Lynn. A sample of 442 women who had breastfed completed an instrument of 56 Likert-scale items. A retest questionnaire was completed by a subsample of 28 women. Exploratory factor analysis resulted in three factors, accounting for 38.5 percent of the variance: Maternal Enjoyment/Role Attainment (29 percent), Infant Satisfaction/Growth (5 percent), and Lifestyle/Maternal Body Image (4 percent). A revised 30-item MBFES was developed using items loading strongly on these three factors. Cronbach's alphas for the revised scale and subscales were .93, .93, .88, and .80, respectively. Test-retest correlations (n = 28) were .93, .93, .94, and .82, respectively (p < .001 for all).

Insufficient milk supply among black and white breast-feeding mothers

The purpose of this study was to investigate whether ethnicity is associated with insufficient milk supply (IMS) among breast-feeding mothers. A major reason reported by mothers for early termination or introduction of formula and/or solids is insufficient milk. A retrospective survey was conducted among 42 black and 148 white breast-feeding mothers participating in the WIC program in a midwestern state. The results suggested that: (1) the incidence of IMS was similar for black and white mothers; (2) controlling for education, black mothers initiated breast-feeding later and stopped sooner; IMS mothers fed less frequently and for shorter periods; and (3) controlling for education, there were no ethnic differences in the determinants or indicators of IMS.

Perspectives of common breastfeeding situations: a known group comparison

Infant feeding choice is influenced by social and cultural factors, as reflected in sociodemographic correlates of breastfeeding, which show consistently low breastfeeding rates among women from low-income populations. This study examines attitudes and beliefs that are thought to affect feeding choice and breastfeeding behavior among diverse social and cultural groups. A breastfeeding behavior questionnaire asking women to respond to a variety of breastfeeding situations presented as narratives was administered to members of a La Leche League group and to a group of WIC participants. Results support the idea that different social groups of women display divergent attitudes toward and perceptions of breastfeeding. Although small sample size prohibits generalization of results, the findings reinforce the necessity of designing breastfeeding education programs within specific cultural contexts.

The relationship of attitudes, knowledge, and social support to breast-feeding

Although more women are initiating breast-feeding, few continue for more than 1-3 months into the postpartum period. The current report studied the relationship of attitudes, social support, experimental and demographic variables, and knowledge to length of breast-feeding. A totaL of 102 women were included in the study and were followed for 1 year. Perceived attitudes toward breast-feeding, selected demographic variables, and past experiences were related to length of breast-feeding.

Predictors of breast-feeding duration among WIC and non-WIC mothers

Many women cease breast-feeding during the first eight weeks after childbirth. Few studies have assessed the relationship of social status to the duration of breast-feeding. This research identified variables that predicted breast-feeding duration for the first eight weeks postpartum among mothers enrolled in the Women, Infants, and Children (WIC) program and those not enrolled. Participation in the WIC program was used as a criterion for measuring socioeconomic status. A total of 400 mothers completed the survey: 200 WIC and 200 non-WIC. A combination of five variables--introduction of formula, maternal perceived success, frequency of breastfeeding, income, and time of initiation of breast-feeding after delivery--explained 48% of the variance in the duration of breast-feeding. The best predictor, introduction of formula, alone accounted for 30% of the variance. There was no difference between aggregates with respect to breast-feeding duration. Findings suggest that a number of variables can be used to identify those at risk for unsuccessful or curtailed breast-feeding, with introduction of formula being the most detrimental.

Potential indicators of insufficient milk supply syndrome

Insufficient milk supply syndrome is a complex phenomenon that has not been adequately investigated. Insufficient milk supply (IMS) is a major reason reported by mothers for early termination of breast-feeding in both developed and developing countries. Using the IMS conceptual framework by Hill and Humenick (1989), a survey was conducted to determine which set of predictors distinguished between mothers who reported an inadequate supply of breast milk (n = 100) from those who reported an adequate supply of milk (n = 284) during the first 8 weeks postpartum. Factor analysis suggested that Potential Determinant factors Maternal Confidence, Paternal Support, Maternal Health, Mother-in-Law Disapproval, and Infant Birthweight accounted for 56.7% of the variance while Potential Indicator factors Baby Behavior, Solid Foods, and Formula accounted for 70.4% of the variance. Using discriminant analysis, factors Maternal Confidence, Maternal Health, Mother-in-Law Disapproval, Baby Behavior, Solid Foods, and Formula predicted 78.04% of the cases accurately. The Potential Indicator factors alone predicted 76.58% of the cases accurately. These findings suggest that the IMS model is valid but additional variables may need to be considered.

A descriptive study of lactation mastitis in long-term breastfeeding women

This descriptive retrospective study surveyed women attending two lactation/breastfeeding conferences about their experiences with mastitis. One-third of the sample reported having mastitis while breastfeeding their last child. Episodes of mastitis occurred most often in the first three months postpartum; however, one-third occurred after six months and nearly one-quarter occurred after one year of breastfeeding. The outer upper quadrants of both breasts were found to be the most frequent sites of infection. The incidence of mastitis in the left and right breasts did not differ. More than one-third of the respondents did not contact their physician when they developed mastitis and and nearly half never used antibiotics for the infection. All respondents reported continuing to breastfeed through the infection. Mothers reported that the following factors (in order of importance) preceded their mastitis: fatigue, stress, plugged duct, change in the number of feedings, engorgement/stasis, an infection in the family, breast trauma and poor diet. Study findings indicate that the most important teaching areas for preventing mastitis are management and control of stress and fatigue.

Insufficient milk supply

A review of the literature reveals the phenomenon of insufficient milk supply (IMS) as being the most likely potential problem for the breastfeeding mother. This article discusses possible determinants and indicators of insufficient milk supply and proposes a conceptual definition and model.

Breast engorgement: contributing variables and variables amenable to nursing intervention

The focus of this study was to identify variables that correlate significantly with breast engorgement and that might be amenable to nursing interventions. Data on the initiation of feeding, frequency of feedings, feeding duration, rate of milk maturation, and supplementation were obtained of 54 women. These variables were found to be significantly correlated with breast engorgement.