Relationship between intention to supplement with infant formula and breastfeeding duration

Exact Gestational Age, Term Versus Early Term, Is Associated with Different Breastfeeding Success Rates in Mothers Delivered by Elective Cesarean Section

Objectives: The study was intended to verify the association between the gestational age of newborns classified as term and the success of breastfeeding in babies born by elective cesarean section. Also, to analyze how the variability of gestational age within the term influences breastfeeding. Materials and Methods: Retrospective study of a cohort, which included full-term newborns and their mothers, whose deliveries occurred by elective cesarean section. Among the inclusion criteria are delivery due to elective cesarean section and minimum gestational age of 37 weeks. The database consisted of medical birth information and interviews with mothers. Results: This study included 954 full-term newborns born by elective cesarean section. Exclusive breastfeeding at 3 months and being breastfed at 6 months showed a statistically significant association in the correlation with the variability of gestational age. There was a statistically significant association between exclusive breastfeeding at 3 months and breastfeeding at 6 months in the correlation between early term and full term. The trend test showed a significant progressive in the breastfeeding curve versus gestational age. Conclusion: Full-term newborns show better results of exclusive breastfeeding at 3 months and continued breastfeeding at 6 months, compared with those born at early term. Gestational age, even in term, has an influence on the success of breastfeeding in newborns undergoing elective cesarean delivery.

Maternal guilt and shame in the postpartum infant feeding context: A concept analysis

Background After birth, guilt and shame are differentially experienced by breastfeeding and formula feeding mothers. Despite this, currently utilized guilt and shame definitions lack context specificity, leaving concepts open to misinterpretation. Objective The current study aimed to develop infant feeding-specific definitions of postpartum guilt and shame. Methods Study selection involved a three-stage systematic screening process, outlined in Jackson et al. (2021). Walker and Avant's (2005, 2019) concept analysis framework was then applied to included articles to identify guilt-specific, shame-specific, and overlapping attributes, antecedents, and consequences. Results A guilt-specific, shame-specific, and overlapping definition were generated based on exclusive and overlapping antecedents, attributes, and consequences. Guilt and shame belonged to the empirical referent Moral Emotions, which may explain some of the overlapping antecedents, attributes, and consequences identified during analysis. Conclusions The overlapping definition provides a broad scope for shared characteristics, while specific definitions allow for more in-depth and focused investigations of guilt and shame experiences within an infant feeding context. Utilising context-specific definitions may serve to improve research homogeneity. Shame was found to be uniquely associated with postnatal depression. As such, suggestions are made for future research to further investigate the relationship between shame, infant feeding, and maternal wellbeing outcomes. Implications Identified antecedents may be used by healthcare professionals to provide additional support to mothers at risk of experiencing guilt and shame, to prevent the occurrence and consequences of these emotions.

Antenatal breastmilk expression for women with diabetes in pregnancy - a feasibility study

Background

Mothers with diabetes are less likely to achieve successful breastfeeding. Antenatal breastmilk expression (ABE) may facilitate earlier breastfeeding, but feasibility of introducing ABE and its acceptance among Scandinavian women have previously not been investigated.

Methods

This observational trial was conducted between the 1 January 2019 and the 12 March 2020 in Tromsø, Norway. We aimed to determine the feasibility of ABE in terms of practicality and acceptability among women with medically (metformin or insulin) treated diabetes. Women were invited to participate during antenatal visits from 32 weeks gestation. Participants received instruction and started ABE from gestation week 37 + 0. Participants, and their infants, were followed until 6–8 weeks after birth. We collected data on breastfeeding rates, infant hypoglycemia, transfer to the neonatal unit, and the women’s overall experience and satisfaction with antenatal breastmilk expression.

Results

Twenty-eight of 34 (82%) invited women consented to participate. All started ABE from week 37 + 0, and continued until hospital admission. No women reported any discomfort or side effects. Labor was induced at 38 weeks gestation. Twenty-four women brought harvested colostrum to the maternity ward, which was given to their infants during the first 24 h of life. Breastfeeding rates at discharge were 24/28 (86%) and 21/27 (78%) at 6–8 weeks after delivery. Seven (25%) infants were transferred to the neonatal unit; four because of hypoglycemia. Maternal satisfaction assessed 6–8 weeks after delivery revealed that all participants felt positive about the ABE, but one woman would not recommend it to other pregnant women.

Conclusions

Implementing a structured ABE guideline for women with medically treated diabetes was feasible. The intervention was associated with high level of satisfaction among study participants. No obvious side effects were observed, and breastfeeding rates at discharge and 6–8 weeks after delivery were higher than in comparable studies.

Trial registration

The study was registered at the research study registry at the University Hospital of North Norway (Nr 2018/7181).

Using Skin-to-Skin Contact to Increase Exclusive Breastfeeding at a Military Medical Center

Evidence shows that early formula supplementation leads to early weaning from exclusive breastfeeding. We implemented an evidence-based practice project on skin-to-skin contact (SSC) for healthy term newborns at a large military treatment facility in an effort to decrease formula supplementation in the early postpartum period. Military women face unique challenges when it comes to breastfeeding. SSC in the early postpartum period is an effective intervention to increase exclusive breastfeeding during the hospital stay and foster future positive breastfeeding outcomes. Through this project, staff knowledge of the benefits of SSC to women and newborns improved and the hospital's exclusive breastfeeding rate increased by 20 percent.

Breastfeeding among Latino Families in an Urban Pediatric Office Setting

Objective. To determine the breastfeeding rate of Latino infants at an urban pediatric clinic in the first six months of life and to identify factors associated with breastfeeding. Methods. Investigators conducted a retrospective chart review of infants seen at the clinic in 2014 as part of a mixed methods study. Topics reviewed included demographics, infant health data, and feeding methods at 5 points in time. Bivariate correlations and cross-tabulations explored associations between variables. Results. Most of the mothers (75%) fed their newborns with both breastfeeding and formula (las dos). At 6 months, a majority were formula-fed only (55.9%). Approximately 10% of mothers exclusively breastfed their newborns, and the trend of exclusive breastfeeding remained steady through the 6-month visit. Over time, the number of mothers who exclusively bottle-feed their infants steadily rises. There were no statistical differences among the feeding method groups with regard to birth order of child, number of adults or children in the household, vaccination rate, number of sick visits, or infants' growth. Conclusions. More targeted attention to this population and other immigrant populations with culturally tailored interventions spanning the prenatal to early infancy periods could increase exclusive breastfeeding and ultimately improve child health.

A Breastfeeding Quality Improvement Project in Rural Primary Care

BACKGROUND

Breastfeeding is the gold standard nutrition for infants, and more than three-fourths of US mother-infant couplets initiate breastfeeding at birth. However, breastfeeding rates plummet after hospital discharge, when mother-infant couplets enter primary care. This quality improvement project examined the effect of a primary care intervention on breastfeeding rates from the newborn visit through the 4-month visit.

OBJECTIVE

The overall aim of this evidence-based quality improvement project was to increase breastfeeding rates by refining the care provided to a diverse patient population with historically low breastfeeding rates.

METHODS

Two independent groups of mother-infant couplets, a pre-implementation (N = 43) and a post-implementation (N = 45), were longitudinally evaluated on breastfeeding rates at the newborn, 1-month, 2-month, and 4-month well-child visits for exclusive, partial, and any breastfeeding rates. Relationships for the 2 groups were compared using 2-sample t tests, chi-square, and Fisher exact tests.

RESULTS

Post-implementation rates for any breastfeeding progressively increased at each timepoint. Exclusive breastfeeding increased 40.98% at the 1-month visit, 27.4% at the 2-month visit, and 139% at the 4-month visit.

CONCLUSION

The implementation of an evidence-based breastfeeding-friendly office protocol in a rural low breastfeeding rate primary care setting was associated with increased breastfeeding rates.

Factors Associated with Supplemental Formula Feeding of Breastfeeding Infants During Postpartum Hospital Stay

OBJECTIVE

To determine reasons potentially amenable to interventions that mothers choose to supplement breastfeeding with formula in the immediate postpartum period.

STUDY DESIGN

We distributed surveys to all mothers in the postpartum unit who delivered a live newborn on day of maternal discharge to assess feeding behaviors during their inpatient admission. We evaluated, when applicable, their reasons for supplementation and examined cultural and demographic information to uncover trends for formula use and potential areas for provider intervention.

RESULTS

Seven hundred twelve of 1,400 mothers responded, of which 478 (65%) reported supplementing breastfeeding with formula (BF+F). The most common reasons for formula supplementation were perception of inadequate milk supply (36.4%), desire for sleep (35.4%), and a plan to breast and bottle feed (35.2%). Exclusive breastfeeding (EBF) was associated with primiparous status (OR 1.95; 95% CI 1.3-3.0), higher education level (OR 2.6; 95% CI 1.7-3.9), and having been breastfed as an infant (OR 1.54; 95% CI 1-2.37). Mothers who experienced skin-to-skin contact also had higher rates of EBF (29.5% versus 19.9%). Factors associated with exclusive formula feeding included single marital status, birth of mother in the United States, Catholic religion, multiparity, and cesarean delivery. Religious and cultural factors also played important roles in maternal feeding behaviors.

CONCLUSION

Clinicians can anticipate risk factors for formula use in mothers who plan to breastfeed and tailor counseling appropriately to increase EBF rates.

No widening socioeconomic gap within a general decline in Swedish breastfeeding

AIM

To study potential socioeconomic differences within the general decline in breastfeeding over time.

METHODS

Data was collected for 51 415 infants born 2004-2010 from the databases of statistics of the Preventive Child Health Care Services in Uppsala and Orebro counties in Sweden and socioeconomic indicators from Swedish national registers. Breastfeeding data (breastfed/not breastfed) from 1 week, 4 months and 6 months of age were used as the main outcome variables. Educational level of the mother was defined as the highest level on a three-grade scale, low, medium and high. Family type was defined as whether the mother was single or married/cohabiting. Family disposable income was divided into quartiles where quartile 1 included the 25% children in families with the lowest incomes. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations (GEE). An exchangeable correlation structure was used to control for the dependence among infants with the same mother.

RESULTS

Breastfeeding rate in Sweden has declined gradually since the late 1990s. The results indicated that overall breastfeeding rates over the study period were influenced by socioeconomic status in a gradient manner but no widening socioeconomic gap was detected. Rather the interaction analyses showed a narrowing socioeconomic gap over the study period between high and low educational level and single versus cohabiting mothers at 4 months. The narrowing socioeconomic gap between the educational level categories was also detectable at 6 months.

CONCLUSION

No increase in socioeconomic gap was detected within the general decline in Swedish breastfeeding. However, there are reasons to maintain and strengthen the overall breastfeeding supportive measures including extended support for vulnerable groups.

Prenatal Anxiety and Infant Feeding Outcomes: A Systematic Review

Prenatal anxiety may negatively affect infant health in multiple domains, including infant feeding. However, the relationship between prenatal anxiety and infant feeding is not well understood. Given the benefits of recommended infant feeding practices, clarifying this relationship is important. This review was conducted to examine the relationship between prenatal anxiety and infant feeding outcomes. Electronic searches were performed in relevant databases. A hand search of selected journals and reference lists of included articles was then conducted. All studies were considered that provided information related to infant feeding outcomes and anxiety during pregnancy. Quality assessment and data extraction were conducted by 2 reviewers; 99 studies were identified, of which 6 were eligible. No associations were found between prenatal anxiety and breastfeeding initiation or breastfeeding in any quantity. However, relationships between high levels of prenatal anxiety and a reduction in both breastfeeding intention and breastfeeding exclusivity were identified. The review was limited by the small number of studies included. Sample sizes lacking power and heterogeneous measures and definitions all significantly affected the comparability of findings. It is concluded that there is insufficient evidence to clarify the relationship between prenatal anxiety and infant feeding outcomes.

Breastfeeding duration: a survival analysis-data from a regional immunization survey

Objective. To report the duration of and factors associated with exclusive and any breastfeeding among the French-speaking community of Belgium (Wallonia). Material and Methods. A two-stage cluster sample was drawn from the population of children aged 18–24 months living in the area in 2012. Anamnestic data on breastfeeding and sociodemographic information were collected from 525 mothers. Cox's proportional hazards model was used to identify factors associated with discontinuing breastfeeding. Results and Discussion. Only 35.1% of the women were satisfied with their duration of any breastfeeding. At 3 months, 54.1% of the infants were breastfed, of which 40.6% exclusively, with these percentages falling to 29.1% and 12.6% at 6 months. Exclusive and any breastfeeding durations were independently positively associated (P < 0.05) with foreign-born mothers, awareness of WHO recommendations, and maternity leave >3 months. Exclusive BF duration was associated with higher parental income and the prenatal decision to breastfeed. The duration of any breastfeeding was associated with the mothers' age of ≥30 years and whether they were exclusively breastfeeding at discharge from the maternity unit. Conclusions. Programs promoting and supporting BF should concentrate on training prenatal health-care professionals. Prenatal professional advice may promote adherence to WHO BF guidelines. The benefits of exclusive BF should be emphasized. Pregnant women should be discouraged from introducing supplementary feeding in the maternity ward.