Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties

AIMS: To examine the relationship between specific reasons for stopping breastfeeding and depressive symptoms in the postnatal period. BACKGROUND: Difficulty breastfeeding has been connected to postnatal depression although it is unclear whether difficulty breastfeeding precedes or succeeds a diagnosis. However, the concept of ‘breastfeeding difficulty’ is wide and includes biological, psychological and social factors. DESIGN: A cross‐sectional self‐report survey. METHODS: Data were collected between December 2012 and February 2013. 217 women with an infant aged 0‐6 months who had started breastfeeding at birth but had stopped before 6 months old completed a questionnaire examining breastfeeding duration and reasons for stopping breastfeeding. They further completed a copy of the Edinburgh Postnatal Depression Scale. RESULTS: A short breastfeeding duration and multiple reasons for stopping breastfeeding were associated with higher depression score. However, in a regression analysis only the specific reasons of stopping breastfeeding for physical difficulty and pain remained predictive of depression score. CONCLUSIONS: Understanding women's specific reasons for stopping breastfeeding rather than breastfeeding duration is critical in understanding women's breastfeeding experience and providing women with emotional support. Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons highlighting the importance of spending time with new mothers to help them with issues such as latch

Attributes of Successful Graduate Students: Facilitating Self-Efficacy and Persistence

Colleges and universities struggle with declining program completion rates among graduate students. While the attrition rate of graduate students declined over the last five years in the United States, the issue of graduate student persistence continues to be challenging. This study identifies and explores reported characteristics: expectations, motivation, self-discipline, emotional intelligence, and passion for learning. Graduate students studying educational leadership conducted a qualitative inquiry to approach theoretical comprehension of the intrinsic motivations, expectations, and major attributes of successful graduate students. Examining these areas provides a deeper understanding of success achieved by graduate students

Hydromethanolic Extracts from Adansonia digitata L. Edible Parts Positively Modulate Pathophysiological Mechanisms Related to the Metabolic Syndrome

Metabolic syndrome includes a cluster of risk factors for many pathological conditions, including hyperglycemia, abdominal obesity, hyperlipidemia, and hypertension. Adansonia digitata L. (also known as baobab) is used in traditional African Medicine and recent studies showed that it improves the metabolism of carbohydrates and lipids. The aim of this study is to investigate the mechanisms of action associated with the beneficial effects of extracts from the edible parts of baobab (fruit pulp, leaves, raw and toasted seeds), evaluating their inhibitory activity against: alpha-amylase, alpha-glucosidase, angiotensin-converting enzyme, 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, and pancreatic lipase. Baobab fruit pulp and leaf extracts resulted to be the most active ones and were then tested on the differentiation process of SW-872 human liposarcoma cells to mature adipocytes. The addition of these latter extracts did not affect triglyceride accumulation, indicating a neutral impact on this parameter. The findings here reported help to explain the growing amount of evidence on the biological properties of baobab and provide suggestions about their use in food and nutraceutical fields

The impact of Baby Friendly Initiative accreditation: An overview of systematic reviews

Abstract: Despite its reported benefits, breastfeeding rates are low globally, and support systems such as the Baby Friendly Initiative (BFI) have been established to support healthy infant feeding practices and infant bonding. Increasingly reviews are being undertaken to assess the overall impact of BFI accreditation. A systematic synthesis of current reviews has therefore been carried out to examine the state of literature on the effects of BFI accreditation. A systematic search of CINAHL, MEDLINE, Maternal and Infant Health, Scopus, the Cochrane Library and PROSPERO was undertaken. Study selection, data extraction and critical appraisal of included reviews using the AMSTAR‐2 tool were undertaken by two authors, with disagreements resolved through discussion with the third author. Due to heterogeneity, a narrative synthesis of findings was applied. Fourteen reviews met the inclusion criteria. Overall confidence in the results of the review was rated as high for three reviews, low for two reviews and critically low for nine reviews. Most evidence suggests some increase in breastfeeding initiation, exclusivity and duration of breastfeeding, and one main trial suggests decreased gastrointestinal infection and allergic dermatitis in infants. However, overall certainty in the evidence was rated as very low across all outcomes due to concerns over risk of bias within and heterogeneity between the original studies. More contemporary, good‐quality randomised controlled trials or well‐controlled prospective comparative cohorts are required to better evaluate the impact of full BFI accreditation, with particular attention paid to the context of the research and to long‐term maternal and infant health outcomes

The decision not to initiate breastfeeding--women's reasons, attitudes and influencing factors--a review of the literature.

Breastfeeding is the biological feeding norm for human babies. Encouraging breastfeeding is a primary health promotion strategy, with studies demonstrating the risks of artificial baby milks. Each year approximately 10% of the women who give birth in New South Wales decide not to initiate breastfeeding, and the demographic characteristics of this group of women have previously been identified. This paper reviews the literature to explore the factors that influence women's decisions about breastfeeding, and their reasons for not initiating breastfeeding. The review revealed there are relatively few studies that explore the experiences of women who decide not to initiate breastfeeding, especially in the Australian context

A methodological review of qualitative case study methodology in midwifery research

© 2016 John Wiley & Sons Ltd Aim: To explore the use and application of case study research in midwifery. Background: Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. Design: A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis. Data Sources: An electronic database search using the date range January 2005–December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central. Review Methods: Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process. Results: The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes. Conclusion: This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting

The impact of the Baby Friendly health Initiative in the Australian health care system: A critical narrative review of the evidence

Studies have identified that the practices of maternity facilities and health professionals are crucial to women's experience of support and breastfeeding 'success'. The Baby Friendly Hospital Initiative (BFHI) was launched globally in 1991 to protect, promote and support breastfeeding. While a direct causal effect has not been established and critics suggest the rhetoric conflicts with women's lived experiences as new mothers, a positive association between the Initiative and breastfeeding prevalence is apparent. Internationally, impact studies have demonstrated that where the Initiative is well integrated, there is an increase in rates of breastfeeding initiation and, to a lesser extent, duration. In consideration of the known health risks associated with the use of artificial baby milks this would suggest that BFHI implementation and accreditation should be a desirable strategy for committed health facilities. However, a variation in both BFHI uptake and breastfeeding prevalence between nations has been reported. This narrative review critically discusses a variety of issues relevant to the uptake and support of breastfeeding and the BFHI, utilising Australia as a case study. Whilst it enjoys 'in principle' policy support, Australia also suffers from a lack of uniformity in uptake and perception of the benefits of BFHI at all levels of the health system. Australian and international studies have identified similar enablers and barriers to implementation

An historical document analysis of the introduction of the Baby Friendly Hospital Initiative into the Australian setting

© 2016 Australian College of Midwives Background Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century. The World Health Organization launched a global health promotion strategy to help create a ‘breastfeeding culture’. Research on the programme has revealed multiple barriers since implementation. Aim To analyse the sociopolitical challenges associated with implementing a global programme into a national setting via an examination of the influences on the early period of implementation of the Baby Friendly Hospital Initiative in Australia. Methods A focused historical document analysis was attended as part of an instrumental case study. A purposeful sampling strategy obtained a comprehensive sample of public and private documents related to the introduction of the BFHI in Australia. Analysis was informed by a ‘documents as commentary’ approach to gain insight into individual and collective social practices not otherwise observable. Findings Four major themes were identified: “a breastfeeding culture”; “resource implications”; “ambivalent support for breastfeeding and the BFHI” and “business versus advocacy”. “A breastfeeding culture” included several subthemes. No tangible support for breastfeeding generally, or the Baby Friendly Hospital Initiative specifically, was identified. Australian policy did not follow international recommendations. There were no financial or policy incentives for BFHI implementation. Conclusions Key stakeholders’ decisions negatively impacted on the Baby Friendly Hospital Initiative at a crucial time in its implementation in Australia. The potential impact of the programme was not realised, representing a missed opportunity to establish and provide sustainable standardised breastfeeding support to Australian women and their families

Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system

Background: The Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as 'baby friendly'. This variance has persisted regardless of BFHI implementation in Australia gaining 'in principle' support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices. Aim: Identify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia. Results: Knowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia. Conclusion: Australian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included. © 2014

Factors influencing Aboriginal and Torres Strait Islander women's breastfeeding practice: A scoping narrative review.

BACKGROUND: The nutritional and health benefits of breastfeeding for infants and young children are well-established however rates of breastfeeding initiation and duration for Aboriginal and Torres Strait Islander children are lower than non-Indigenous children. AIM: To describe factors influencing breastfeeding practice amongst Aboriginal and Torres Strait Islander women. METHODS: A scoping narrative review was conducted using the Joanna Briggs Institute framework. A search was conducted in four online databases (PubMed, Scopus, ANU SuperSearch, and Science Direct). Findings were analysed using [30] narrative synthesis. FINDINGS: This review included 9 journal articles, a conference summary and a book. This review identified four factors influencing women's breastfeeding practice; sources of support, culturally appropriate care, intention to breastfeed and social determinants. CONCLUSION: Multiple social determinants resulting from colonization have interrupted traditional infant feeding practices and women's sources of support. Although Aboriginal and Torres Strait Islander women have strong intention to breastfeed, their breastfeeding outcomes are impacted by lack of pro-breastfeeding support when encountering breastfeeding challenges as well as norms surrounding the use of infant formula milk. Culturally appropriate care is essential for identifying women's needs and avoiding stereotyping. Further research is needed to investigate the effectiveness of breastfeeding interventions for this group of women