Cesarean delivery as a factor promoting exclusive breastfeeding in Japan

Postpartum Nipple Symptoms: Risk Factors and Dermatologic Characterization

Background: Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. Methods: A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Results: Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Conclusion: Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.

Relationship between postpartum depression and lactation status at a Japanese perinatal center: A cross-sectional study

Background:  Some studies have demonstrated that breastfeeding can protect mothers from postpartum depression; therefore, we examined the association between postpartum depression and lactation status at one month after delivery at a Japanese perinatal center.

Methods: We reviewed the obstetric records of all (total 809) nulliparous healthy women with vaginal singleton delivery at 37-41 weeks’ gestation at our institute between July 2018 and June 2019. A face-to-face interview with the women was conducted on admission for delivery to ask whether or not they hoped to perform exclusive breastfeeding for their babies, and an additional interview was conducted one month after delivery to ask about their feeding methods currently. Maternal mental status was examined based on the scores using the Edinburgh Postnatal Depression Scale (EPDS), and women with EPDS scores of ≥9 points were regarded as ‘positive screening’.

Results: 592 women (73.1%) hoped to perform exclusive breastfeeding for their babies on admission. Of these, at one month, 442 (74.7%) performed exclusive breastfeeding, while 150 (25.3%) performed mixed or artificial feeding. The average EPDS scores and the incidence of EPDS scores ≥9 points in the women performing exclusive breastfeeding were 4.3 ± 3.6 and 14.3% (63/442), respectively. They did not differ from those in the women performing mixed or artificial breast feeding [4.2 ± 3.7, p = 0.60 and 13.3% (20/150), p = 0.78].

Conclusion: Development of postpartum depression does not seem to be associated with incomplete breastfeeding at our hospital, and therefore there are other risk factors indicated in the development of postpartum depression.

The Short Form of the Breastfeeding Self-Efficacy Scale as a Prognostic Factor of Exclusive Breastfeeding among Mandarin-Speaking Chinese Mothers

BACKGROUND

Little is known about the effect of maternal perceived breastfeeding self-efficacy on the exclusive breastfeeding rate at 6 months postpartum in mainland China.

OBJECTIVE

The aim of this study was to examine the relative effect of maternal breastfeeding self-efficacy and selected relevant factors on the exclusive breastfeeding rate at 6 months postpartum. The internal consistency and construct validity of the Chinese (Mandarin) version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) were also examined.

METHODS

This was a prospective cohort study conducted at a regional teaching hospital in Guangzhou, China. A total of 562 in-hospital mothers who were within 72 hours postpartum were recruited to the study and followed up by telephone for 6 months.

RESULTS

Although all of the mothers breastfed their babies within 72 hours postpartum, only 25% of the mothers breastfed exclusively. The mean survival time of continuation of exclusive breastfeeding was 16.7 days. The proportion of mothers who breastfed exclusively after discharge was 14.8%, 2.0%, and 0.2% at 1, 4, and 6 months, respectively. Cox regression analysis revealed that the mothers who had a higher BSES-SF score at baseline, underwent cesarean section, and practiced exclusive breastfeeding within 72 hours after delivery were significantly associated with a lower hazard of discontinuation of exclusive breastfeeding before 6 months postpartum.

CONCLUSION

The exclusive breastfeeding rate among Chinese women is far from satisfactory. The Chinese (Mandarin) version of the BSES-SF can help in identifying mothers who need more support for exclusive breastfeeding before 6 months postpartum.

Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis

AIM

To provide comprehensive evidence of the effect of interventions on early initiation, exclusive, continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above.

METHODS

Of 23977 titles identified through a systematic literature search in PUBMED, Cochrane and CABI, 195 articles relevant to our objective, were included. We reported the pooled relative risk and corresponding 95% confidence intervals as our outcome estimate. In cases of high heterogeneity, we explored its causes by subgroup analysis and meta-regression and applied random effects model.

RESULTS

Intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding rates, were seen when counselling or education were provided concurrently in home and community, health systems and community, health systems and home settings, respectively. Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding.

CONCLUSION

To promote breastfeeding, interventions should be delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.

Nipple pain, damage, and vasospasm in the first 8 weeks postpartum

BACKGROUND

Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage.

SUBJECTS AND METHODS

A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study.

RESULTS

After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage.

CONCLUSIONS

Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.