Factors influencing the feeding of first-born infants

Factors Related to the Duration of Breast-Feeding in Ankara, with Special Reference to Sociocultural Aspects

A questionnaire designed to elicit information on the relationship between certain sociocultural factors and the duration of breast-feeding was administered to 1,500 mothers. Giving colostrum, demand feeding, night feeding, feeding with both breasts, rooming-in, and planned pregnancy were factors found to have a positive effect on the duration of breast-feeding. Factors having a negative association included the use of prelacteal foods, mothers’ educations, smoking, and maternal employment. For employed mothers, paid maternity leave before and after delivery did not affect the duration of breast-feeding, but unpaid maternity leave and milk leave had a positive effect.

UK-born ethnic minority women and their experiences of feeding their newborn infant

OBJECTIVE

to explore the factors that impact on UK-born ethnic minority women's experiences of and decisions around feeding their infant.

DESIGN

in-depth semi-structured interviews.

PARTICIPANTS

34 UK-born women of Black African, Black Caribbean, Pakistani, Bangladeshi, Indian and Irish parentage and 30 health-care professionals.

SETTING

women and health-care professionals were recruited primarily from hospitals serving large numbers of ethnic minority women in London and Birmingham.

FINDINGS AND CONCLUSIONS

despite being aware of the benefits of exclusive breast feeding, many women chose to feed their infant with formula. The main barriers to breast feeding were the perceived difficulties of breast feeding, a family preference for formula feed, and embarrassment about breast feeding in front of others. Reports from women of South Asian parentage, particularly those who lived with an extended family, suggested that their intentions to breast feed were compromised by the context of their family life. The lack of privacy in these households and grandparental pressure appeared to be key issues. Unlike other participants, Irish women reported an intention to feed their infant with formula before giving birth. The key facilitators to breast feeding were the self-confidence and determination of women and the supportive role of health-care professionals.

IMPLICATIONS FOR PRACTICE

these findings point to common but also culturally specific mechanisms that may hinder both the initiation and maintenance of breast feeding in UK-born ethnic minority women. They signal potential benefits from the inclusion of family members in breast-feeding support programmes.

Physicians Ask for More Problem-Solving Information to Promote and Support Breastfeeding

Physicians (n=262) were surveyed about their breastfeeding promotion practices, knowledge, and areas in which they need more information in order to be more influential with patients in the initiation and duration of the process. Over half (51%) reported no or limited education in breastfeeding, whereas only 9% reported adequate education. A knowledge assessment indicated almost half (42%) did not know certain viruses can be transmitted through breast milk. There were also mixed responses to the need for vitamin D supplementation. Promotion practices included most (82%) thinking the physician has a primary role in the feeding decision, and most did discuss the benefits with patients; however, only 54% would recommend breastfeeding to a patient who had decided to bottle-feed. Problem-solving was the main area physicians reported needing more education. Partnerships with dietetics professionals may fill the gaps in the support needed to increase rates of breastfeeding.

Promoting breast-feeding in a deprived area: the influence of a peer support initiative

The present article describes a qualitative study designed to evaluate the effectiveness of a peer-support intervention to promote breast-feeding in a deprived area. The aims of the study were to: explore stakeholders' experiences of the intervention; explore the development of a 'culture' of breast-feeding; and consider the potential of the initiative for building community capacity. The methods used in the research were in-depth interviews, diaries and direct observation. The findings describe the social and cultural barriers to breast-feeding experienced by women, and the ways in which professional and lay participants in the peer-support project attempt to reduce them. The advantages of partnership working between health professionals and lay volunteers are then explored. These include: sharing the workload; providing an informal tier of support to mothers; and importantly, offering support and advice stemming from personal experience. For lay supporters, the benefits of taking part in the project range from personal satisfaction at being recognised as skilled, to gains in confidence which potentially open up further educational and training opportunities. In conclusion, it is suggested that the 'success' of such interventions is unlikely to be captured solely by monitoring breast-feeding rates, but needs to take into account the wider context of community development.

Independent predictors of breastfeeding intention in a disadvantaged population of pregnant women

BACKGROUND

Breastfeeding rates in Scotland are very low, particularly in the more disadvantaged areas. Despite a number of interventions to promote breastfeeding very few women actually intend to breastfeed their baby. The aim of this study was to identify personal and social factors independently associated with intention to breastfeed.

METHODS

Nine hundred and ninety seven women from two socio-economically disadvantaged housing estates located on the outskirts of Glasgow participated in a study that aimed to increase the prevalence of breastfeeding. Self-administered questionnaires completed by each participant collected information in early pregnancy, prior to exposure to the study intervention, on feeding intention, previous feeding experience and socio-demographic data.

RESULTS

Five factors were independently predictive of breastfeeding intention. These were previous breastfeeding experience, living with a partner, smoking, parity and maternal age. After adjusting for these five factors, neither deprivation nor receipt of milk tokens provided useful additional predictive information.

CONCLUSION

In this population of socially disadvantaged pregnant women we identified five variables that were independently predictive of breastfeeding intention. These variables could be useful in identifying women at greatest risk of choosing not to breastfeed. Appropriate promotional efforts could then be designed to give due consideration to individual circumstances.

Qualitative study of decisions about infant feeding among women in east end of London

OBJECTIVE

To improve understanding of how first time mothers who belong to a socioeconomic group with particularly low rates of breast feeding decide whether or not to initiate breast feeding.

DESIGN

Qualitative semistructured interviews early in pregnancy and 6-10 weeks after birth.

SETTING

Women's homes in east end of London.

SUBJECTS

21 white, low income women expecting their first baby were interviewed mostly at home, often with their partner or a relative. Two focus groups were conducted.

RESULTS

Women who had regularly seen a relative or friend successfully breast feed and described this experience positively were more confident about and committed to breast feeding. They were also more likely to succeed. Exposure to breast feeding, however, could be either a positive or a negative influence on the decision to breast feed, depending on the context. Women who had seen breast feeding only by a stranger often described this as a negative influence, particularly if other people were present. All women knew that breast feeding has health benefits. Ownership of this knowledge, however, varied according to the woman's experience of seeing breast feeding.

CONCLUSIONS

The decision to initiate breast feeding is influenced more by embodied knowledge gained from seeing breast feeding than by theoretical knowledge about its benefits. Breast feeding involves performing a practical skill, often with others present. The knowledge, confidence, and commitment necessary to breast feed may be more effectively gained through antenatal apprenticeship to a breastfeeding mother than from advice given in consultations or from books.

What influences the uptake and early cessation of breast feeding?

OBJECTIVE

To examine obstetric, maternal and social factors associated with the uptake and early cessation of breast feeding and women's reasons for altering from breast to bottle feeding.

DESIGN

Women who responded to a postal questionnaire on long-term postpartum health were contacted and asked to participate in a home-based interview. In addition to health problems, the interview obtained information on baby feeding and a number of social factors. Women were also asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and maternal data were obtained from maternity records.

SETTING

Deliveries from a large maternity hospital in Birmingham.

PARTICIPANTS

906 women were interviewed at a mean of 45 weeks after delivery.

FINDINGS

63% of the women said they had breast fed, but 40% of these stopped within three months of delivery. Many of the women gave physical problems with lactation as reasons for stopping. The factors found to be predictors of early cessation were: return to work within three months of birth; regular childcare support from other female relatives, and a high EPDS score. Non-initiation of breast feeding was predicted by a different set of factors: multiparity; general anaesthetic (GA); and unmarried status.

DISCUSSION AND CONCLUSION

Despite evidence of the benefits of breast feeding, this remains an unacceptable long-term option for many women, and for over one-third it is never attempted. Factors within the woman's social environment were found to influence early cessation. Women who had a GA during or immediately following labour and delivery were less likely to initiate breast feeding.

IMPLICATIONS FOR PRACTICE

If breast-feeding incidence and duration are to increase, more attention should be paid to establishing early, successful breast feeding and countering the negative influences of factors within the social environment.

The resurgence of breastfeeding in the United States

OBJECTIVE

To update reported rates of breastfeeding through 1995 and to compare rates in 1995 with those from 1989.

METHODS

The Ross Laboratories Mothers' Survey, first conducted in 1955, is a large, national, mail survey designed to determine patterns of milk feeding to 6 months of age. Questionnaires are mailed to a representative sample of mothers when their infants are 6 months of age. In 1989, 196 000 questionnaires were mailed, and in 1995, 720 000 questionnaires were mailed. Mothers were asked to recall the type of milk fed to their infants immediately after birth, in the hospital, and during each of the first 6 months of age. The rates of breastfeeding in the hospital and at 6 months of age were evaluated.

RESULTS

The Ross Laboratories Mothers' Survey demonstrates recent increases in both the initiation of breastfeeding and continued breastfeeding at 6 months of age. Comparing rates in 1989 and 1995, the initiation of breastfeeding increased more than 14% (from 52.2% to 59.7%). There was a 19.3% increase in the rate of breastfeeding at 6 months of age (from 18.1% to 21.6%). The increases in breastfeeding were observed across all sociodemographic groups but were greater among groups that have historically been less likely to practice breastfeeding: women who were black, younger (<25 years of age), in the lowest income group (<$10 000), no more than grade school educated, primiparous, and living in the South Atlantic region of the United States; women who had infants of low birth weight; women who were employed full time outside the home; and women who participated in the Women, Infants, and Children supplemental food program. Nevertheless, breastfeeding was most common in the western states and among women who were older, college educated, and multiparous, did not enroll in the Women, Infants, and Children program, were not employed outside the home, had infants of normal birth weight, and had higher disposable incomes.

CONCLUSION

The sharp increase in rates of breastfeeding among groups that are less likely to breastfeed is encouraging. However, these groups are still the least likely to initiate breastfeeding. Educational efforts that extol positive attitudes about breastfeeding must be continued to support mothers who are young, poor, and less educated.

Impact of attitudes on maternal decisions regarding infant feeding

It is essential that physicians and other health care professionals seeking to increase the rate of initiation and duration of breast-feeding build on the body of information concerning factors that influence a woman's attitudes about breast-feeding. The relation between positive attitudes concerning breast-feeding and its initiation is important to the development of programs targeting women before they become pregnant, and to the provision of active support for breast-feeding throughout the pregnancy, perinatal, and postnatal period. However, it is not sufficient for these programs to target only the mother or potential mother; members of a woman's social network must be considered as information targets. Educational programs must also be directed to the appropriate racial or ethnic group to develop programs that reach the individuals (father, female relative, or friend) most likely to influence the mother's breast-feeding decision. Physicians may be very knowledgeable about the nutritional and immune properties of human milk and yet not be supportive of the act of breast-feeding. This lack of support may be manifested by the lack of verbal support for women who intend to or are in the process of breast-feeding, the provision of infant formula before or at the time of birth of the baby, or encouragement to terminate breast-feeding should the mother encounter any difficulties with lactation. To increase physician awareness of the process of breast-feeding and the properties of human milk, information about the benefits should be integrated in both the basic science and the clinical curricula of medical schools. Primary care training programs, including obstetrics, should actively involve trainees in the management of breast-feeding women so that trainees become aware of the spectrum of circumstances that confront women seeking to establish and maintain successful breast-feeding. This type of involvement would provide a contextual base for physicians' understanding the attitudes and behaviors supportive of breast-feeding. Attitudes and behavior of women, although more complex then demographic factors, provide a powerful tool for meeting the Healthy People 2000 goals for the initiation and duration of breast-feeding. It is important to build on the base of research reviewed here to develop new and and more powerful interventions. Thus the emphasis on the known health advantages of human milk or the discovery of additional health benefits of breast-feeding should continue to be discussed because they may tip the balance in favor of breast-feeding for some women. Nevertheless, it may ultimately be more important to increase the amount of information provided to women (and girls and boys) about the practical aspects of the breast feeding process (e.g., ease of night feeding, fathers ability to feed mother's milk by bottle, lower cost, strategies to control leaking) then to rely solely on the positive health outcomes related to breast-feeding.

The infant feeding decision in low and upper income women

Few studies have described the woman who chooses breast-feeding by more than simple demographics. The purpose of our study was to characterize new mothers by their infant feeding decisions, by demographic and obstetrical data, and by sources of personal support they received during their pregnancies and in making their infant feeding decisions. To this end, 220 were interviewed, including 116 who chose to breastfeed. Breast-feeding women were more likely to be older, more educated, married, more affluent, experienced with breast-feeding, to have demonstrated good prenatal habits, and to have received support from other sources than those who chose bottle feeding. Participation in Lamaze classes, previous successful breast-feeding, and maternal education were significant predictors of feeding choice, and mode of delivery predicted duration of breastfeeding. Low income women who chose breastfeeding resembled low income bottle feeders in certain medical/social factors, but they showed support patterns similar to middle to upper income women.

Effect of two types of hospital feeding gift packs on duration of breast-feeding among adolescent mothers

Two hundred forty-four adolescent mothers under 18 years of age were surveyed during a 15-month period, and 53% elected to breast-feed. A subset of 60 primiparous breast-feeding adolescents were enrolled in an investigator-blind, randomized, prospective study to compare the effects on breast-feeding duration of a standard hospital discharge feeding gift pack containing formula and a specially designed study pack that was free of infant formula. Thirty-five percent of the 60 women breast-fed less than 1 month; 22% nursed longer than 1 month but less than 2 months; and 43% breast-fed more than 2 months. There was no significant difference in breast-feeding duration among mothers by gift pack group, although those who received the study gift pack rated it higher in usefulness (p less than (0.025). The provision of infant formula samples did not appear to have a deleterious effect on the duration of breast-feeding among a population of adolescent mothers.

Compliance with a dietary manipulation programme in families with infants prone to atopy

The success of familial compliance with a dietary manipulation programme was studied prospectively in 91 newborn babies from atopic families for up to 12 months. The control group consisted of 72 infants from non-atopic families. The percentages of infants breast-fed at the age of six months were 58% and 38% in the study group and control group, respectively. The introduction of cow's milk based formulas was postponed until the age of three months in 63% of the infants in the study group and 47% of the infants in the control group. Solid food was avoided during the first three months in 76% and 45% of the infants in the study group and control group, respectively. Maternal age, smoking and low social class were associated with poor compliance. The existence of atopic dermatitis in any member of the family was associated with good compliance. The main advantages of our programme were the increased number of children breast-fed until the age of six months, and the reduced number of infants introduced to cow's milk based formulas or solid food before three months of age.

Factors associated with maternal choice to provide breast milk for low birthweight infants

Factors associated with maternal choice to provide milk for premature infants were investigated in 925 mother/infant pairs in five hospitals. A well educated, married, primiparous mother aged 20 or over who delivered a baby boy by caesarean section was nearly 1000 times more likely to choose to express her milk than a mother who was poorly educated, single, multiparous, and aged under 20, delivering a female infant vaginally. Evidence from the five centres suggested that hospital staff have little influence on a mother's choice of feeding method. The major differences between the populations of babies whose mothers do or do not choose to provide milk, raise important issues concerning the interpretation of data from non-randomised clinical trials of feeding premature infants.

Hospital routines in infants with hyperbilirubinemia influence the duration of breast feeding

Twenty-nine infants undergoing phototherapy to treat hyperbilirubinemia were divided into two groups. One group of mothers (non-separated) were transferred with their infants to the paediatric ward and remained as the primary care provider. The other group of mothers (separated) remained on the maternity ward and went to the paediatric unit to care for their infants at feeding times. A third group of healthy mothers and infants served as controls. Mothers in the non-separated group were more satisfied with the care than mothers in the separated group. The duration of breast feeding in the separated group was significantly shorter than in the other groups. The urine cortisol levels in the separated mothers were the same at one week and three months after delivery. The mothers in the other two groups had significantly higher urine cortisol levels during the first week postpartum than three months postpartum. We conclude that routine phototherapy for jaundiced infants should not separate mothers and infants.

Medical management of successful breast-feeding

Despite the present climate of professional and lay enthusiasm for breast-feeding, many women experience problems in the initiation of lactation, either because of misinformation, secondary lactation difficulties, or primary failure of lactation. This article provides pediatricians with practical guidelines for the successful initiation of breast-feeding and the prevention and early detection of problems. Recommendations are made for optimal prenatal preparation for breast-feeding, intrapartum routines that facilitate lactation, appropriate early follow-up of nursing infants, and the management of the full normal course of breast-feeding.