Factors contributing to early breast-feeding cessation among Chinese mothers: An exploratory study

Background although more than 85% of all new mothers in Hong Kong now initiate breast feeding, few exclusively breast feed and the overall duration is short. More than one-third stop breast feeding within the first month post partum. Objective to explore the breast-feeding experiences of Hong Kong Chinese mothers who prematurely discontinue breast feeding and to identify contributing factors that might be remediated to help women breast feed longer. Design qualitative exploratory study. Methods in-depth, exploratory interviews were carried out with 24 new mothers who stopped breast feeding within one month after birth, and content analysis was used to analyse the data. Findings five core themes emerged from the data: unnatural expectations, left to figure it out, uncertainty, unfulfilling experiences, and guilt versus relief. Because breast feeding is ‘natural’ participants expected that it would come naturally and thus be easy. When breast feeding did not happen naturally, however, midwives were too busy to provide breast-feeding support and mothers were left to figure it out on their own. Participants also reported difficulty in gauging whether the infant was getting adequate nutrition from their breastmilk. Few participants had positive breast-feeding experiences; while the decision to stop breast feeding caused guilt for most participants, others expressed relief at stopping breast feeding. Key conclusions and implications for practice greater postnatal breast-feeding support, both in the hospital and after the mother returns home, would likely increase the mother׳s confidence and enhance her mothering experience. Further antenatal and postnatal education on the realistic breast-feeding expectations and the amount of breastmilk required by babies is also important. More research is needed to test professional and peer support breast-feeding interventions to provide guidance to policy makers on the most effective breast-feeding support strategies.postprin

Association between Intrapartum Interventions and Breastfeeding Duration

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Determinants of 2009 A/H1N1 influenza vaccination among pregnant women in Hong Kong

During the 2009-2010 A/H1N1 influenza pandemic, pregnant women infected with the virus experienced excess morbidity and mortality when compared with other groups. Once a vaccine was available, pregnant women were a priority group for vaccination. Only a few studies have reported on the uptake of 2009 A/H1N1 influenza vaccine among pregnant women during the pandemic and none were from Asia. The purpose of this study was to examine factors associated with 2009 A/H1N1 influenza vaccine uptake among pregnant women in Hong Kong. Using a multi-center, cross-sectional design, we recruited 549 postpartum women from four post-natal wards in Hong Kong over a 4-month period during the second wave of the A/H1N1 influenza pandemic in the winter and spring of 2010. Only 6.2% (n = 34) of participants had received the 2009 A/H1N1 influenza vaccine and 4.9% (n = 27) had received the seasonal influenza vaccine. The most common reasons for not receiving the 2009 A/H1N1 vaccine were fear of causing harm to themselves or their fetus. A high knowledge level (OR = 19.06; 95% CI 5.55, 65.48), more positive attitudes (OR = 3.52; 95% CI 1.37, 9.07), and having a family member who had the 2009 A/H1N1 influenza vaccine (OR = 7.69; 95% CI 2.92, 20.19) were independently and positively associated with vaccination. Study results show an unacceptably low uptake of the pandemic A/H1N1 influenza vaccine among pregnant women in Hong Kong. Interventions to increase influenza vaccine knowledge and uptake among this group should be a priority for future pandemic planning and seasonal vaccination campaigns.published_or_final_versio

Predictors and Consequences of In-hospital Formula Supplementation for Healthy Breastfeeding Newborns

BACKGROUND: Although exclusive breastfeeding is recommended for the first 6 months, the use of breast milk substitutes is widespread around the world. OBJECTIVES: To describe the patterns of infant formula supplementation among healthy breastfeeding newborns, to identify factors contributing to in-hospital formula supplementation, and to assess the dose-response relationship between the amount of in-hospital formula supplementation and the duration of any breastfeeding. METHODS: A sample of 1246 breastfeeding mother-infant pairs was recruited from 4 public hospitals in Hong Kong and followed prospectively for 12 months or until weaned. Multiple logistic regression analysis was used to examine factors associated with in-hospital supplementation. Cox regression analysis was used to explore the impact of in-hospital supplementation on breastfeeding duration. RESULTS: Of the total, 82.5% of newborns were supplemented in the hospital; one-half received formula within 5 hours of birth. Assisted vaginal delivery (odds ratio [OR] = 2.06, 95% confidence interval [CI] 1.03, 4.15), cesarean section (OR = 3.45, 95% CI 1.75, 6.80), and higher birth weight (OR = 1.56, 95% CI 1.12, 2.18) were positively associated with in-hospital formula supplementation, whereas initiating breastfeeding in the delivery room (OR = 0.55, 95% CI 0.33, 0.89) was associated with decreased likelihood of in-hospital supplementation. Any infant formula in the first 48 hours was associated with a shorter duration of breastfeeding (hazard ratio [HR] = 1.51, 95% CI 1.27, 1.80), but there was no dose-response effect. CONCLUSION: In-hospital formula supplementation is common in Hong Kong hospitals and appears to be detrimental to breastfeeding duration. Continued efforts should be made to avoid the provision of infant formula to breastfeeding babies while in the hospital unless medically indicated.postprin

Increase in Weight in Low Birth Weight and Very Low Birth Weight Infants Fed Fortified Breast Milk versus Formula Milk: A Retrospective Cohort Study

There has been a dramatic rise in preterm births in developed countries owing to changes in clinical practices and greater use of assisted reproductive techniques. However, few studies have examined the growth and outcomes of preterm infants according to the type of feeding (with fortified breast milk or formula). The purpose of this study was to examine the effect of breast milk feedings and formula on the growth and short-term outcomes of preterm infants in Hong Kong. In a single-center retrospective cohort study, we included 642 preterm infants at gestational age <37 weeks with birth weights <2200 g. According to World Health Organization criteria, 466 were classified as low birth weight (LBW) infants (≥1500 g and <2200 g) and 176 were classified as very low birth weight (VLBW) infants (<1500 g). The mothers of approximately 80% of VLBW infants and 60% LBW infants initiated breast milk feeding. When compared with no breast milk intake, LBW infants that received breast milk were significantly more likely to have growth z-scores closer to the median of the reference population on admission and experienced slower weight gain from birth to discharge. When breast milk was categorized by percent of total enteral intake, significant differences were seen among LBW infants, with lower percentages of small-for-gestational-age (SGA) status at discharge with increased proportions of breast milk intake. Our results suggest that LBW infants fed breast milk had better growth z-scores and lower SGA status at discharge compared with those predominately fed preterm formula.published_or_final_versio

Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula

Background: The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps. Objectives: To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates. Methods: We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report. Results: After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95). Conclusion: After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.postprin

Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breast-feeding duration

OBJECTIVE: To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration. DESIGN: Prospective cohort study. SETTING: In-patient postnatal units of four public hospitals in Hong Kong. SUBJECTS: Two cohorts of breast-feeding mother-infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding. RESULTS: The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose-response pattern. CONCLUSIONS: After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.postprin

Presenteeism in hospital nurses

This quantitative, descriptive, cross-sectional research aimed to determine the estimated productivity of health-related limitations at work in 129 nurses working in direct care delivery to critical and potentially critical patients. Instruments were applied for socio-demographic and functional characterization and for the evaluation of presenteeism (Work Limitations Questionnaire). Statistical Package for the Social Sciences software was used for data analysis. In this study, 75% of nurses obtained a lost productivity index of up to 4.84%. The physical demand domain represented the major limitation for these professionals (25%). Presenteeism was directly correlated to health care, occurrence and number of absences, and indirectly related to work time at the unit. It was concluded that organizational or individual factors influence individuals' productivity, in view of the circumstances involving care delivery to critical and potentially critical patients.Estudio cuantitativo, descriptivo y transversal con el objetivo de determinar la productividad supuesta de las limitaciones en el trabajo relacionadas con la salud de 129 enfermeros que asisten a pacientes críticos y potencialmente críticos. Se utilizó un instrumento para la caracterización sociodemográfica y funcional y para la evaluación de la presencia. Se realizó un análisis estadístico de los datos con el software Statistical Package for the Social Sciences. En este estudio, 75 % de los enfermeros obtuvieron un índice de productividad perdida de hasta 4,84%. La demanda física fue el dominio que presentó mayor limitación (25%). La presencia se relacionó directamente a: realización de tratamiento de salud, ocurrencia y número de faltas, e indirectamente al tiempo en la unidad. Se concluye que existe influencia de factores organizacionales o individuales en la productividad del individuo frente a las circunstancias que involucran la asistencia al paciente crítico y potencialmente crítico.Este é um estudo quantitativo, descritivo e transversal com o objetivo de determinar a produtividade estimada das limitações no trabalho, relacionadas à saúde, em 129 enfermeiros atuantes na assistência direta a pacientes críticos e potencialmente críticos. Utilizou-se instrumento para caracterização sociodemográfica e funcional e para a avaliação do presenteísmo (questionário de limitações no trabalho). Procedeu-se à análise estatística dos dados com o software Statistical Package for the Social Sciences. Neste estudo, 75% dos enfermeiros obtiveram índice de produtividade perdida de até 4,84%. A demanda física foi o domínio que representou maior limitação para esses profissionais (25%). O presenteísmo correlacionou-se diretamente à realização de tratamento de saúde, ocorrência e número de faltas, e indiretamente ao tempo de trabalho na unidade. Conclui-se que existe influência de fatores organizacionais ou individuais na produtividade do indivíduo, frente às circunstâncias que envolvem a assistência ao paciente crítico e potencialmente crítico

An exploration of the knowledge and attitudes towards breastfeeding among a sample of Chinese mothers in Ireland

<p>Abstract</p> <p>Background</p> <p>Psychological factors are important in influencing breastfeeding practices. This retrospective study explored knowledge and attitudes related to breastfeeding of Chinese mothers living in Ireland.</p> <p>Methods</p> <p>A cross-sectional self-administrated survey written in Chinese was distributed to a convenience sample of 322 immigrant Chinese mothers mainly <it>via </it>Chinese supermarkets and Chinese language schools in Dublin, with the involvement of the snowball method to increase sample size. Maternal breastfeeding knowledge and attitudes were described, their associations with socio-demographic variables were explored by Chi-square analysis, and their independent associations with breastfeeding behaviours were estimated by binary logistic regression analyses.</p> <p>Results</p> <p>In spite of considerable awareness of the advantages of breastfeeding (mean score = 4.03 ± 0.73), some misconceptions (<it>e</it>.<it>g</it>. 'mother should stop breastfeeding if she catches a cold') and negative attitudes (<it>e</it>.<it>g</it>. breastfeeding inconvenient, embarrassing, and adverse to mothers' figure) existed, especially among the less educated mothers. Cultural beliefs concerning the traditional Chinese postpartum diet were prevalent, particularly among those who had lived in Ireland for a shorter duration (P = 0.004). Psychological parameters had strong independent associations with breastfeeding practices in this study. Those who had lower awareness score (OR = 2.98, 95% CI: 1.87-4.73), more misconceptions and negative attitudes (P < 0.05), and weaker cultural beliefs (P < 0.05) were less likely to breastfeed.</p> <p>Conclusions</p> <p>Findings highlight a need to focus resources and education on correcting the misconceptions identified and reversing the negative attitudes towards breastfeeding among Chinese mothers in Ireland, in particular those with primary/secondary level of education. Mothers' cultural beliefs should also be acknowledged and understood by healthcare providers.</p