Feeding Twins with Human Milk and Factors Associated with Its Duration: A Qualitative and Quantitative Study in Southern Italy

Breastfeeding Challenges Experienced by Mothers Following Multiple Births-a Systematic Review and Meta-Synthesis of Quantitative, Qualitative, and Mixed-Methods Studies

Background: Breastfeeding is vital for infant nutrition, especially for multiple babies (twins) born prematurely, yet breastfeeding rates among mothers of twins are lower compared with mothers of singleton babies. This review presents a synthesis of research findings on breastfeeding challenges experienced by mothers following twins' births. Methods: The electronic databases of CINAHL, MEDLINE, PsycINFO, EMBASE, and Web of Science were systematically searched in August 2023. All eligible quantitative, qualitative, and mixed-methods studies reported on breastfeeding challenges experienced by mothers of twins were included. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and followed Lucas et al.'s framework for thematic synthesis. Two reviewers independently screened all studies by title, abstract, and full text. The methodological quality of studies was independently assessed by two reviewers using the Joanna Briggs Institute critical appraisal tool and mixed-methods appraisal tool based on study design. Results: The review included 16 studies: quantitative (n = 5), qualitative (n = 8), and mixed methods (n = 3), published between 1980 and 2022, involving 3,351 mothers from 16 countries. Three main themes were generated as follows: (1) transitioning to a new role, finding the balance between self and the newborns' needs; (2) the inevitability of emotional challenges; and (3) navigating support and information. Conclusion: The integrated findings of quantitative, qualitative, and mixed-methods studies on challenges experienced by mothers of twins will have scope for researchers to address the challenges through tailored intervention, education, and support and can help health care professionals revisit policy and practices to extend support services for mothers of twins beyond the initial postpartum and to the community for improving breastfeeding practices among mothers following multiple births.

Reflections of adolescent motherhood on infant and young child feeding practices: the case of Uganda

BACKGROUND

Age-appropriate breastfeeding and adequate complementary feeding play a crucial role in reducing under-5 mortality rates, malnutrition, and mortality worldwide. Given the high prevalence of adolescent pregnancy in Uganda, we aimed to assess the competence of adolescent mothers in infant and young child feeding (IYCF) using data from the 2016 Uganda Demographic Health Survey.

METHOD

Our sample comprised the last children aged 6-23 months of mothers aged 15-29 years, totaling 2594 mother-infant pairs; 402 were aged 15-19 years, 1,388 were aged 20-29 years with their first delivery before the age of 20, and 804 were aged 20-29 years with their first delivery at 20 years or older. We utilized complex sample logistic regression analysis to examine the interactions between adolescent motherhood and IYCF indicators during the previous day of the survey.

RESULTS

The rates of ongoing breastfeeding, bottle feeding, minimum meal frequency, minimum dietary diversity, minimum acceptable diet, egg and/or flesh food consumption, zero vegetable or fruit consumption, and unhealthy food consumption were found to be 77.7%, 16.3%, 37.5%, 28.7%, 14.2%, 41.7%, 31.6%, and 14.7%, respectively. Multivariate complex sample logistic regression revealed that women with a history of adolescent pregnancy had lower odds of achieving minimum meal frequency, and higher odds of zero vegetable or fruit consumption.

CONCLUSION

Adolescent mothers and women who give birth during their teenage years are particularly vulnerable to inadequate infant and young child nutrition practices. Targeted interventions and education programs should be implemented to promote optimal complementary feeding practices among mothers in Uganda.

A qualitative investigation of experiences of breastfeeding twins and multiples

BACKGROUND

Research has found that twins and multiples are less likely to be breastfed than singleton babies. Exploration of the experience of breastfeeding twins and multiples from parents' perspectives is limited, and we know little about the experiences of those who breastfeed twins and multiples and the possible barriers they face.

AIM

The aim of the research was to explore experiences of breastfeeding twins and multiples in the UK from the perspective of birthing parents.

METHODS

A qualitative online survey was carried out (n = 94), followed by online semi-structured interviews (n = 18). The data were analysed using reflexive thematic analysis.

FINDINGS

Four themes were developed from the data: (1) "It's one of the things I'm most proud of in my life" (2) The importance of support: "it definitely takes a village with twins" (3) Barriers and the pressure to formula feed: "all they wanted to do was stuff 'em full of formula" and (4) The dynamic experience of breastfeeding twins.

DISCUSSION

Many of the participants were able to feed their babies in part due to sheer determination and the refusal to give up when met with challenges. Breastfeeding was an important part of their identity as a mother, however mental health was often impacted by their experiences, as well as the challenges they faced when seeking support.

CONCLUSION

Breastfeeding twins and multiples is a challenging yet rewarding experience. Our findings indicate that further training and support is needed to enable healthcare providers to support parents of twins on their breastfeeding journey.

Breastfeeding Practices in the Twin Town of India - A Cross-Sectional Study

The global rise in twinning rates poses health challenges due to increased risks for infants and mothers. Despite the benefits, breastfeeding rates among multiples are low, with exclusive breastfeeding (EBF) particularly scarce compared to singletons. Our study focuses on the mothers of twins in a unique population in Kodinhi village, Kerala, India, known for its high twinning rates, which aims to contribute to existing knowledge of breastfeeding practices and perspectives in a high twinning environment and offer valuable insights to promote optimal breastfeeding among mothers of twins. A retrospective cross-sectional survey was adopted. Seventy-five mothers with twins under 3 years of age from Kodinhi and neighboring areas were interviewed face to face using structured validated tools. Data collection focused on quantitative data supplemented by narrative descriptions. Most women delivered preterm (57.3%), operative delivery (58.7%), and had a late initiation of breastfeeding (32.9% within 24 hours). Colostrum feed was common (86.7%). The EBF rate was 4%, with 47.9% initiating nonexclusive breastfeeding before 3 months, and most of the twins (46.6%) were breastfed for 1-2 years. Fatigue (69.9%) and low milk supply (38.7%) were chief concerns. While 16.4% of mothers opted for a tandem breastfeeding technique, many preferred consecutive feeding as tandem was challenging. Mothers in Kodinhi demonstrated commendable efforts in breastfeeding twins; despite the low rate of EBF, breastfeeding extended to 1-2 years. Evidence-based interventions and personalized support, primarily focusing on maternal perspectives of milk insufficiency, fatigue and breastfeeding techniques, are crucial for sustaining optimal breastfeeding practices among mothers of twins.

The breastfeeding experience of women with multiple pregnancies: a meta-synthesis of qualitative studies

BACKGROUND

The experiences and challenges associated with breastfeeding multiple births can be considerably more complex than those of singletons. Multiple births refer to the delivery of more than one offspring in a single birth event. Emphasizing the needs and experiences of mothers with multiple births during breastfeeding can enable healthcare providers to design targeted interventions that enhance breastfeeding rates. However, existing breastfeeding and health education resources and practices do not fully meet the needs of women who breastfeed multiples. This review aimed to review and synthesize qualitative studies on the breastfeeding experiences of women with multiple births.

METHODS

A systematic search was conducted in 10 electronic databases for papers published from the inception of the database to March 2024. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was utilized to evaluate the methodological quality of the studies included. The thematic synthesis method of Thomas and Harden was employed to integrate and analyze the included literature to derive new categories and conclusions.

FINDINGS

Eight studies met the inclusion criteria and quality assessment criteria for this study. Through the integration of their results, four themes were identified: the choice and willingness to breastfeed multiple births; the challenges of breastfeeding multiple births; stage management and individualised adaptation of breastfeeding; and the experience of support.

CONCLUSION

Throughout the feeding process from pregnancy to the postpartum period, mothers with multiple births often have predominantly negative experiences with breastfeeding. Consequently, hospitals should create a multidisciplinary follow-up team comprising obstetrics, neonatology, psychology, and community services to offer specialized and personalized support to these women at various stages.

SYSTEMATIC REVIEW REGISTRATION

[ https://www.crd.york.ac.uk/PROSPERO/ ], identifier [PROSPERO 2024 CRD42024520348].

The effect of perceived social support on fatigue in mothers having twin infants: the mediating role of sleep quality

The aim of this study is to investigate the mediating role of sleep quality in the relationship between multidimensional perceived social support and fatigue among mothers of twin infants. One hundred and six (106) twin mothers participated in this cross-sectional study, who completed the Descriptive Information Form, Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Checklist Individual Strength. The scale score averages of the mothers in the study are as follows: social support, 61.41 ± 23.86; fatigue, 77.64 ± 28.68; and sleep quality, 8.26 ± 2.38. According to the path model, perceived social support has a negative effect on poor sleep quality (p = .001, Beta = -0.411), and poor sleep quality has a positive effect on fatigue (p = .001, Beta = 0.335). Sleep quality also mediates the effect of multidimensional perceived social support on mothers' fatigue levels (p = .001, Beta = -0.138). The study results suggest that the perceived social support and fatigue levels of twin mothers are moderate, while their sleep quality is poor. Therefore, mothers of twin infants may benefit from increased social support to alleviate fatigue and enhance sleep quality.

The effectiveness of online breastfeeding education and support program on mothers of preterm infants: A quasi-experimental study

OBJECTIVE

To develop a WeChat-mini-program-based Online breastfeeding education and support program and explore its impacts on promoting mothers of preterm infants' breastfeeding knowledge, attitudes, self-efficacy, and rates.

DESIGN, SETTING, AND PARTICIPANTS

This was a quasi-experimentation with two-group comparisons. The eligible preterm mother-infant pairs were recruited from the NICU within seven days postpartum. The first 25 mothers admitted to the NICU during the study period were included in the control group, and the following 25 mothers were in the intervention group according to the admission order of their preterm infants. A generalized linear mixed model was used to detect the effects of the online intervention program and the interaction effects of group and time.

INTERVENTIONS

The participants received a 3-month online breastfeeding intervention from a WeChat mini program for the intervention group.

MEASUREMENTS

Mothers of preterm infants' breastfeeding knowledge, attitudes, self-efficacy, and breastfeeding rates of different patterns were respectively evaluated by the Breastfeeding Knowledge Questionnaire (BKQ), Iowa Infant Feeding Attitude Scale (IIFAS), and Breastfeeding Self-Efficacy Scale (BSES) at three different points of times including before intervention (T0), at one month postpartum (T1) and three months postpartum (T2).

FINDINGS

The breastfeeding knowledge significantly differed between the two groups but without differences between different time points and in the grouping*time interaction. Within the intervention group, significant improvements were observed from T0 to T2 and T1 to T2. No significant differences in breastfeeding attitudes, self-efficacy, and breastfeeding rates were found between and within groups.

KEY CONCLUSIONS

The WeChat-mini-program-based online breastfeeding intervention may improve the breastfeeding knowledge level of mothers of preterm infants but has no significant impact on mothers' breastfeeding attitudes, breastfeeding self-efficacy, and breastfeeding rates.

IMPLICATIONS FOR PRACTICE

The WeChat mini program can be used to improve the breastfeeding knowledge level of mothers of preterm infants. Future interventions need to target both mothers of preterm infants and their family members by combing online and offline approaches.

Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants-A Narrative Review

Aware of the utmost importance of feeding premature babies-especially those of lower weight-with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk.

Analysis of the duration of exclusive breastfeeding in premature infants and its influencing factors

PURPOSE

The purpose of this study was to investigate the duration of breastfeeding among preterm infants within the first 12 months after birth and analyzed factors influencing the duration of exclusive breastfeeding.

DESIGN AND METHODS

In this retrospective study, premature infants who were hospitalized in the Neonatal Intensive Care Unit (NICU) premature delivery area of a third-class maternal and child health hospital in Changsha City, Hunan Province, China from October 2020 to January 2021 were selected as the participants for this study. Relevant data of these infants during their hospitalization was obtained from the hospital information system, while the rate of exclusive breastfeeding among preterm infants at a corrected age of 12 months was tracked through telephone follow-up. Univariate analysis of the effects of breastfeeding duration in preterm infants was conducted based on Mann-Whitney U test and Kruskal-Wallis H test. Multiple linear regression was then applied to determine the factors influencing the duration of exclusive breastfeeding in preterm infants.

RESULTS

The median and interquartile range of breastfeeding duration for preterm infants in this study was 4.00 (1.00, 6.00) months. Multiple linear regression analysis showed that the duration of exclusive breastfeeding was affected by several factors including how much other family members support breastfeeding, whether the mother returns to work after maternal leave, and whether the infant is a twin (P < 0.05).

CONCLUSION

The duration of exclusive breastfeeding among preterm infants needs to be improved by strengthening health education regarding the benefits of breastfeeding for preterm infants. Medical staff should provide guidance, encourage continuous nursing after discharge, and work with the community to implement targeted intervention measures with the goal of increasing the duration of exclusive breastfeeding among premature infants.

IMPLICATIONS TO PRACTICE

Because breastfeeding is vitally important for premature infants, we should encourage longer breastfeeding duration for premature infants by increasing family support, removing barriers to workplace breastfeeding, enhancing people's confidence in breastfeeding and providing support to mothers with twins. Hopefully, these measure can promote breastfeeding for premature infants.

Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge

Mothers' own milk (MOM) for premature babies is considered a life-saving drug for its proven protective action against the complications of prematurity and for effects on outcome in the short and long term, especially neurological ones. We studied the use of MOM for infants weighing <1500 g for a period of 5 years, evaluating the trend over time and the impact of some variables on human milk feeding performance. Statistical comparisons concerned the rate of feeding with breast milk during a stay in an NICU and at discharge with respect to two types of variables: (1) maternal and neonatal characteristics (gestational age, birth weight, type of pregnancy (whether single or twin), maternal age) and (2) feeding characteristics (time of the start of minimal enteral feeding and availability of MOM, days until the achievement of full enteral feeding). Group comparisons were performed using ANOVA or t-test for continuous variables and Pearson chi-squared test or Fisher exact test for categorical variables. We observed an increase, between 2017 and 2021, in MOM use (p = 0.003). The availability of the own mothers' milk occurred, on average, on the fourth day of life and improved over the years. The start of minimal enteral feeding (MEF) with human milk averaged 1.78 days, and 54.3% of VLBWs received MEF with donor milk on the first day of life. The average percentage of feeding with the mothers' milk at discharge was 47.6%, with 36.1% of exclusive MOM and an increase from 45.8% in 2017 (33.3% exclusive) to 58.82% (41.18% exclusive) in 2021. The mean average daily growth of the weight improved (p < 0.001) during this period, and there was no statistical difference between infants fed with maternal milk and those fed with bank milk. Older maternal age, early-start feeding with maternal milk and low gestational age had a statistically significant impact on feeding with MOM at discharge.

Exploring Tandem Breastfeeding Motivations Via Self-Determination Theory: An Interpretative Phenomenological Study

BACKGROUND

Tandem breastfeeding is defined as a situation in which a mother continues breastfeeding her child through a subsequent pregnancy, including after the new baby is born. In some countries where motherhood may be delayed and the time between births may be reduced, support for the promotion of tandem breastfeeding is necessary to help mothers continue to breastfeed their eldest child and avoid early weaning. There is no existing research about mothers' motivations to breastfeed in tandem.

RESEARCH AIM

To explore the motivations of women to initiate and maintain tandem breastfeeding, based on their lived experience, framed within the self-determination theory.

METHODS

A prospective, cross-sectional, interpretive, phenomenological study was carried out through in-depth interviews with 15 mothers in Madrid, who had practiced tandem breastfeeding for more than 6 months, and whose weaning of their eldest child had occurred within the previous year. Convenience and snowball sampling were used. The data were analyzed using an established interpretive phenomenological analysis process.

RESULTS

Among the motivations for initiating tandem breastfeeding, the following themes were identified: "avoid wasting the effort invested," "desire such life experience," and "exercise the freedom to decide." The motivations for maintaining tandem breastfeeding were classified as "pass on parenting values" and "benefits of teamwork."

CONCLUSION

The participants based their motivation to tandem breastfeed to follow their freely chosen motherhood model. They discovered the advantages of its implementation, forming a team of themselves and their children, and healing their traumatic perinatal experiences.

Determinants and Factors Associated with the Maintenance of Exclusive Breastfeeding after Hospital Discharge after Birth

The benefits of exclusive breastfeeding are well known for both mother and baby. Despite this, rates of exclusive breastfeeding remain low. The present study aimed to determine the factors associated with the maintenance of this type of feeding after being discharged from the hospital after childbirth. A cross-sectional study was carried out with 1200 postpartum women in Spain. Sociodemographic, obstetric, and neonatal data were collected. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were calculated. Early breastfeeding initiation was identified as a factor that favors breastfeeding after hospital discharge (aOR: 2.47; 95%CI: 1.77, 3.45). Other factors that favor breastfeeding after discharge included the woman feeling very supported by her partner during pregnancy, childbirth, and the puerperium (aOR: 2.54; 95%CI:1.30, 5.00) and having previously breastfed other children (aOR: 1.97; 95%CI: 1.40, 2.76). Among the factors that hindered exclusive breastfeeding after discharge were multiple or twin pregnancies (aOR: 0.31; 95%CI 0.12, 0.83), induction of labor (aOR: 0.73; 95%CI: 0.53, 0.99), admission of the newborn to the neonatal intensive care unit (NICU) (aOR: 0.31; 95%CI 0.19, 0.52), using epidural pain relief during labor (aOR: 0.41; 95%CI: 0.27, 0.64), or a preterm newborn (aOR: 0.38; 95%CI: 0.21, 0.69). For all these reasons, it is essential to promote certain practices such as the early start of breastfeeding or the induced onset of labor, among others, in order to promote the maintenance of exclusive breastfeeding beyond hospital discharge after childbirth.