Breastfeeding in the Boston suburbs in relation to personal-social factors. Are pediatricians thoughtlessly influencing the outcome in their postpartum care?

Perceived breast milk insufficiency in mothers of neonates hospitalized in neonatal intensive care unit

OBJECTIVE

A) To study the frequency of perceived breast milk insufficiency in mothers of hospitalized neonates. b) To assess subsequent duration of exclusive breast feeding and growth (upto three months) in neonates whose mothers perceived breast milk insufficiency.

METHODS

Neonates whose mothers were willing to breastfeed their babies were included in the study. Their breastfeeding status was assessed and the mother's perception of breastfeeding was elicited as per WHO guidelines. In mothers who perceived breast milk insufficiency (crisis group), causes for such a perception were looked into. Mothers were regularly counseled to breastfeed the infant After discharge the mother infant dyad were followed up for three months and babies evaluated for weight, length and head circumference.

RESULTS

Three hundred and seven neonates and their mothers fulfilling the inclusion criteria were enrolled in the study. Perceived breast milk insufficiency was present in 208 (68%) mothers. Common reasons for such a perception were irrational. In the crisis group, 35% mothers had preterm babies as compared to 16% in the non crisis group (p =0.001). One hundred and fifty three mothers (73.33%) in the crisis group had breast milk sodium levels>16 mmol/L as compared to 12 mothers (12.12%) in the non crisis group (p 0.001). Micturition <6 times/24 hours was reported in 166 (83%) mothers in crisis group as compared to 18 (18.1%) mothers in non crisis group. All mothers who perceived breast milk insufficiency could be helped by lactation management and exclusively breastfed their babies. All infants were exclusively breastfed at discharge and at three month follow up. The growth of the infants was satisfactory in the crisis group at 3 months follow up.

CONCLUSION

The Present study suggests that lactation failure following delayed initiation of breastfeeding can be countered by subsequent intensive counselling. Emphasis is required on counselling for breastfeeding in primary neonatal care.

Do nurses help or hinder mothers who breastfeed?

A 5-week programme of breastfeeding inservice education, included classes on a repeated series of three topics, a film, provision of reading material, tests and the availability of a nurse-clinician for consultation and assistance. The study was carried out in a 50-bed maternity unit. Participation was voluntary. Of the 112 registered nurses and 42 practical nurses, between one-third and one-half participated in one or more of the various aspects. Follow-up tests revealed considerable disagreement among the staff on knowledge and nursing interventions related to breastfeeding.

Breast-feeding in Spain

Human milk is the best way to nurture the human infant. By breast-feeding their babies, mothers provide them with the best opportunities to wholly develop their potential, while protecting the infants and themselves from a whole range of diseases in the near future and in the years to come. Even though these benefits are widely known and there is ample scientific evidence on the topic, it seems from published data that Spanish women are not breast-feeding their babies as much and for as long as they should. Less than 90% start breast-feeding, at 1 month there is already an attrition of 30%, at 3 months more than half of the infants are taking artificial milk and by 6 months only 10% continue to breast-feed their infants. Low birth weight, Caesarean section and low study level are among the more significant factors that negatively affect breast-feeding. There is still work to do to improve this situation. Promotion of breast-feeding among the general population, mothers and health professionals is needed.

The effect of work status on initiation and duration of breast-feeding

OBJECTIVES

In this study, longitudinal data are used to examine the effect of work status on breast-feeding initiation and duration.

METHODS

Mothers from a mail panel completed questionnaires during late pregnancy and 10 times in the infant's first year. Mother's work status was categorized for initiation by hours she expected, before delivery, to work and for duration by hours she worked at month 3. Covariates were demographics; parity; medical, delivery, and hospital experiences; social support; embarrassment; and health promotion.

RESULTS

Expecting to work part-time neither decreased nor increased the probability of breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and .89, P > .50), but expecting to work full-time decreased the probability of breast-feeding (OR = .47, P < .01). Working full-time at 3 months postpartum decreased breast-feeding duration by an average of 8.6 weeks (P < .001) relative to not working, but part-time work of 4 or fewer hours per day did not affect duration, and part-time work of more than 4 hours per day decreased duration less than full-time work.

CONCLUSION

Part-time work is an effective strategy to help mothers combine breast-feeding and employment.

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.

Breastfeeding care in Ohio hospitals: a gap between research and practice

OBJECTIVE

To assess current breastfeeding care in Ohio hospitals and compare that care to research-based principles.

DESIGN

Survey.

SETTING

Ohio hospitals that provide maternity care.

PARTICIPANTS

All 141 Ohio hospitals that provide maternity care were invited to participate. One-hundred sixteen (83%) hospitals returned usable surveys completed by obstetric nurse managers.

MAIN OUTCOME MEASURE

A 38-item questionnaire provided data on hospital demographics and information regarding the care of breastfeeding mother-infant dyads.

RESULTS

Research-based practices common in Ohio's hospitals include demand feeding, breastfeeding education, and breastfeeding as the initial neonatal feeding. Common non-research-based practices include supplemental fluid administration, postpartum nipple treatments, mandatory initial nursery stays, limited sucking time, restricted maternal-infant contact, distribution of formula packs, minimal follow-up care, and the suspension of breastfeeding for hyperbilirubinemia.

CONCLUSIONS

Despite positive changes in perinatal care, a number of non-research-based practices persist in Ohio hospitals for the care of the breastfeeding mother-infant dyad.

Body mass index and duration of breast feeding: a survival analysis during the first six months of life

STUDY OBJECTIVE

The aim was to determine whether excess weight in lactating women is associated with earlier cessation of breastfeeding.

DESIGN

The study was to prospective cohort analysis using a community sample of women.

SETTING

Geelong the regional centre of the Barwon Region of Victoria, Australia, in 1984-85.

SUBJECTS

All women who were breast feeding and whose first infant was born between 1 May 1984 and 30 April 1985 were asked to participate. Of these, 739 women participated, a response rate of 81%.

MAIN RESULTS

Smoking, mother's age and occupation, the time the infant was first put to the breast, and mother's body mass index at one month postpartum all exerted statistically significant independent effects on the duration of breast feeding, assessed using Cox's proportional hazards regression modelling. The strongest effects were for smoking, with an adjusted relative risk for cessation of breast feeding of 2.5 (95% CI 1.9 to 3.1) for 10 cigarettes per day v no smoking, and maternal age, with relative risk of 2.2 (95% CI 1.5 to 3.1) for a 20 year old mother relative to a 30 year old. The relative risk for women with a body mass index above 26 was 1.5 (95% CI 1.1 to 2.0).

CONCLUSIONS

Excess weight at one month postpartum, as determined by a body mass index above the normal range, was found to be an independent risk factor for early cessation of breast feeding and together with smoking, maternal age, occupation, and the time the infant is first put to the breast can be used to identify, early in the postpartum period, those women most likely to benefit from counselling in order to breast feed their infants successfully.

Risk factors for early termination of breast feeding in Brazil

A prospective study was undertaken to identify possible factors related to the duration of breast feeding. Two hundred and thirty-eight mothers who had delivered normal single babies with birth weights greater than 2.5 kg and had initiated breast feeding were randomly selected at the maternity hospital, Hospital de Clinicas de Porto Alegre, Brazil, and followed by mail questionnaires until termination of breast feeding, or until the end of the first year. If no reply was received, telephone contact or home visits were made. The group of mothers who stopped breast feeding prior to the end of the third month was compared with those who extended breast feeding beyond three months with respect to socioeconomic, biological, environmental, medical and psychological factors. The variables with a significant coefficient of association with early termination of breast feeding were maternal education, past experience with breast feeding, help of a maid, help with housework provided by a relative, breast feeding orientation during prenatal care and encouragement from the husband. These factors act simultaneously, with interactions among them.

An educational intervention on promotion of breast feeding

This study was designed to search for an effective method to promote exclusive breast feeding among Turkish city women delivering in hospitals. Four hundred and forty-two primiparae with uncomplicated deliveries and with healthy infants with birthweights of greater than 2500 g were exposed to a group educational session on breast feeding after birth, followed by one repeat session at home. Four hundred and ninety-nine women served as controls. All homes were visited monthly for 6 months by independent observers and data relevant to the feeding of the infants were collected. Weight measurements of 176 infants were taken at age 4 months. The study and control mothers were similar in sociodemographic characteristics which reflected a low socio-economic/educational background but relatively good housing conditions. Although significant differences in frequency of exclusive breast feeding were found between the study and control groups, the impact of the intervention was much lower than our expectations and short-lived. Type of feeding was not related to sex or birthweight of the infant, nor to maternal variables. Weight at age 4 months was within normal limits and similar in the study and control groups. It was concluded that lack of up-to-date information on infant feeding was the main obstacle to breast feeding in urban groups in Turkey, and that the impact of an educational intervention limited to the first week after delivery was lost within the first 2 months.

Practices and policies in the initiation of breastfeeding

Despite increasing knowledge about factors affecting the initiation of breastfeeding, many mothers still encounter problems and discontinue breastfeeding earlier than desired. Many hospitals still have not implemented the practices that are known to be helpful in the establishment of breastfeeding. As a result, a study was conducted to examine the policies and practices affecting breastfeeding in hospitals in Alberta, Canada. A questionnaire-based survey of all Alberta hospitals (including directors of nursing and staff nurses) found that many practices were still relatively inflexible; did not always reflect accurate, research-based information; and were not geared to the needs of mothers and infants. The implications of these findings are discussed.

Management of hypernatremic dehydration due to insufficient lactation

Critical malnutrition and hypernatremic dehydration resulting from inadequate breast-feeding have previously been reported; the finding of elevated sodium concentration in expressed samples of mother's milk from these infants is found concurrently. This is the first case report describing successful relactation following management of hypernatremic dehydration in a breast-fed infant. Mother's milk was of inadequate volume and had a high sodium content. Treatment of the primary cause of this disorder, insufficient lactation, was effective in allowing successful relactation; a nursing supplementer is described.

Patterns of infant feeding in the first six months

A quasi-experimental six months longitudinal study of women planning to breastfeed was carried out in Vancouver, B.C., Canada. The purpose was to increase breastfeeding duration through the provision of nursing support, and information about breastfeeding. This paper reports on the patterns of infant feeding by 131 mothers for six months postpartum. Included are data on initiation of breastfeeding, feeding intervals, supplementation, initiating semi-solids and duration of breastfeeding. Unsupplemented breastfeeding declined from 90.8% at the time of discharge from hospital to 65% at one month, 45% at three months and 3.9% at six months. For some infants, semi-solids were introduced at one month and by three months 11.4% were being fed semi-solids. The implications for health care professionals caring for breastfeeding women are outlined.

Attitudes and practice of kuwaiti women toward breastfeeding

A survey was conducted to assess the attitudes towards breastfeeding, its prevalence and duration among Kuwaiti married women. Five hundred eighty-five women from different regions of the country with at least one child of their own, willing to furnish data were included in the survey. The results of this study show that 71 percent of newborns are breastfed at birth. The percentage of breast-fed infants declines to 50 percent by the time they are one month old, and to 10 percent among five-month-old infants. The expected duration of breastfeeding is about two months. This study also reveals a wide gap existing between the attitudes, knowledge and practice of breastfeeding among Kuwaiti women. Their attitude towards breastfeeding is largely positive. This study emphasizes that with appropriate health education and supportive measures sensitive to the needs of this community, breastfeeding can retain its integral part in the process of human reproduction and child development.

Successful breast feeding: the mother's dilemma

A content analysis of 141 articles on breast feeding by discipline revealed differences in the factors considered necessary for breast feeding success and in the criteria used to determine success. Whereas medical articles focused on maternal factors prenatally and infant health post-natally, or the length of time breast feeding was maintained, lay articles focused on the relationship of the mother with her infant (the nursing couple) and the mother's ability to manage breast feeding within the family context. The implications of this discrepancy for nursing practice and research are discussed.

Possible related risks to breastfeeding

Animal studies have identified a mouse mammary tumor agent transmitted through lactation that increases the incidence and reduces the age for tumor development in offspring. A similar viral particle has been detected with greater frequency in the milk of humans with a family history of breast carcinoma than in the milk of those with no history. Animal studies also indicate that a male offspring who has been breastfed, at low risk himself, could possibly transmit the agent through seminal fluid. The health team is encouraged to consider these factors when discussing infant feeding methods with women who have a positive family history of breast carcinoma.

Trends and Differentials in Breast Feeding: An Update

Analysis of the 1973 National Survey of Family Growth shows a continued downward trend in breast feeding by successive cohorts of American mothers. The downward trend is evident in both measures of incidence (ever-breast feeding) and duration of breast feeding for first and higher-order births. For all cohorts higher-order births are less likely to be breast fed than first births. However, breast feeding of higher-order births is typically of a longer duration. Differentials in breast feeding reveal strong associations with indicators of social class; women who are college graduates, who work as professionals, and who are married to professional husbands are most likely to breast-feed their infants. Differentials in average duration of breast feeding are often reversed from differentials in ever-breast feeding.

The obstetrician's opportunity: translating "breast is best" from theory to practice

The superiority of breast-feeding to artificial feeding of infants has been well established for nutritional, biochemical, antiinfective, psychological, economic, and contraceptive reasons. The promotion of breast-feeding should, therefore, be a high-priority concern of health workers. Both provision of information and support to expectant mothers and changes in hospital routines in the perinatal period have been shown capable of dramatically increasing the incidence and duration of breast-feeding in populations studied. Moreover, these interventions are interventions are quite specific, effective, manageable, and affordable. Obstetricians have a special responsibility and capacity to promote breast-feeding given their contact with women throughout pregnancy and their influence on hospital birth routines. A greater commitment on the part of obstetricians to promote breast-feeding could accelerate and extend the current shift back to breast-feeding, to the benefit of mothers and their babies in all socioeconomic groups.