Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings:an integrative review

Background: Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review’s objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy. Methods: A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework. Results: From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis – the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group. Conclusion: Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.</p

The baby friendly health initiative in Australia : a case study of the uptake and development of a global programme into a national setting

University of Technology Sydney. Faculty of Health.Background: Breastfeeding has many known benefits. In 1991, the United Nations International Emergency Children’s Fund launched a global health strategy to help maternity facilities create a safe environment that supported women’s infant feeding decisions and practice; the Baby-friendly Hospital Initiative. In Australia, the Baby Friendly Health Initiative is governed by the Australian College of Midwives and receives ‘in principle’ policy support from the Commonwealth government. There are currently 70 maternity facilities (approximately 24%) registered as ‘baby friendly accredited’. Aim: To analyse the past and current policy support of breastfeeding in Australia with a specific focus on the Baby Friendly Health Initiative. Methods: The study used an instrumental case study design by examining a 'case' to provide insight into a particular issue of interest and facilitating the understanding of 'something else'. The case was the Baby Friendly Health Initiative (BFHI) in Australia, the issue of interest was the dissemination of a global health strategy in a national setting; and the ‘something else’ was the ongoing and future support of breastfeeding in Australia. Data collected, reviewed and thematically analysed included: 14 participant interviews, organisational minutes and correspondence, international and national policy documents and government reports. A modified knowledge translation model provides a conceptual framework. Findings: Triangulation of the findings revealed common themes. The conceptual model demonstrated the presence of enablers and barriers to the translation of knowledge and evidence into practice. Enablers for the uptake and development of the Baby Friendly Health Initiative in Australia are intangible, consisting of an altruistic belief in breastfeeding support as important for women, babies and the world. Barriers are tangible: widespread inadequate resourcing has constrained delivery of the Baby Friendly Health Initiative at local levels and created internal tensions. Future expansion requires authentic government engagement and tangible incentives in collaboration with key stakeholders. Conclusion: The political decision to fragment breastfeeding policy and situate it within a nutrition framework rather than as a standalone programme with a whole of government approach has had far-reaching consequences. The future of the Baby Friendly Health Initiative in Australia is heavily reliant on political will and level of resourcing

An instrumental case study examining the introduction and dissemination of the Baby Friendly Health Initiative in Australia: Participants' perspectives

© 2017 Australian College of Midwives Background: Australia experiences high breastfeeding initiation but low duration rates. UNICEF introduced the global breastfeeding strategy, the Baby-Friendly Hospital Initiative, to Australia in 1992, transferring governance to the Australian College of Midwives (ACM) in 1995. In 2017 23% of facilities were registered as ‘baby-friendly’ accredited. Aim: To examine the introduction and dissemination of the Baby-friendly Hospital Initiative into the Australian national setting. Methods: An instrumental case study was conducted containing two components: analysis of historical documents pertaining to the Initiative and participant's interviews, reported here. A purposive sampling strategy identified 14 participants from UNICEF, ACM, maternity and community health services, the Australian government and volunteer organisations who took part in in-depth interviews. Thematic analysis explored participants’ perceptions of factors influencing the uptake and future of the since renamed Baby Friendly Health Initiative (BFHI) and accreditation programme, BFHI Australia. Two broad categories, enablers and barriers, guided the interviews and analysis. Findings: Participants revealed a positive perception of the BFHI whilst identifying that its interpretation and expansion in Australia had been negatively influenced by intangible government support and suboptimal capacity building. BFHI's advocacy agenda competed with BFHI Australia's need for financial viability. Widespread stakeholder collaboration and tangible political endorsement was seen as a way to move the strategy forward. Conclusion: Dissemination of BFHI Australia is hampered by multi-level systems issues. Prioritisation, stakeholder collaboration and adequate resourcing of the BFHI is required to create a supportive and enabling environment for Australian women to determine and practice their preferred infant feeding method