The Role of Positive Emotions in Perinatal Mental Health and Breastfeeding

Major medical organizations in the U.S. recommend exclusive breastfeeding for six months, with continued breastfeeding through the first year or longer as desired by the woman and her infant. Public health programs have primarily aimed to increase breastfeeding duration and exclusivity without addressing the emotional experience of breastfeeding. Barbara Fredrickson’s broaden-and-build theory of positive emotions suggests that experiences of positive emotions lead to adaptive benefits by broadening thoughts and actions, facilitating the accrual of resources to improve health and well-being. In the context of the postpartum, this theory suggests that positive emotions experienced during infant feeding may broaden the scope of a mother’s thoughts and actions, allowing her to build resources to cope with challenges. We used longitudinal data from the Mood, Mother and Infant cohort of women followed from the third trimester across the first year postpartum to test the extent to which positive emotions during infant feeding were associated with postpartum depression and anxiety and breastfeeding outcomes. We used generalized linear mixed effects models and time-to-event analyses to explore these associations, exploring modification by women’s baseline psychopathology. Among women without a diagnosis of prenatal depression, positive emotions during feeding were inversely associated with postpartum depression symptoms. On the other hand, among women with a diagnosis of prenatal anxiety, positive emotions were associated with significantly lower postpartum anxiety symptoms. We speculate that women with prenatal anxiety who neverthess enjoy the experience of infant feeding may benefit from anxiolytic effects of oxytocin during breastfeeding and mother-infant interaction. Positive emotions were not significantly associated with time to any breast milk feeding cessation; however, positive emotions were significantly associated with a longer time to exclusive breast milk feeding cessation and with a better overall maternal breastfeeding experience, especially with dimensions of maternal enjoyment, role attainment, and lifestyle compatibility. Positive feelings about breastfeeding in the first week were similarly associated with breastfeeding outcomes, suggesting the importance of the early maternal experience of breastfeeding on long-term outcomes. Mother-centered programs and policies that support the experiential aspects of infant feeding may improve postpartum mental health, breastfeeding rates, and maternal satisfaction with breastfeeding.Doctor of Philosoph

Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3: Prenatal Breastfeeding Education

BACKGROUND: The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity. METHODS: The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies. RESULTS: Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women's partners or family are involved. However, varying study quality and lack of standardized assessment of participants' breastfeeding intentions limited the ability to recommend any single intervention as most effective. CONCLUSION: Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions

An Assessment of the Impact of the Mary Rose Tully Training Initiative (MRTTI) Upon Alumnae Satisfaction and Career Development

Background: The Mary Rose Tully Training Initiative (MRTTI) is an International Board Lactation Consultant Examiners (IBLCE)-approved Pathway 2 clinical training program in breastfeeding and lactation. MRTTI is a part of the Carolina Global Breastfeeding Institute (CGBI), and the program boasts a 100% pass rate on the international Board Certified Lactation Consultant (IBCLC) exam. Prior to this assessment, MRTTI had not assessed alumnae satisfaction or career outcomes.Purpose: To ascertain the effectiveness of the MRTTI in improving graduates’ career prospects.Methods: A 35-question mixed methods Qualtrics survey was created and disseminated among MRTTI alumnae in March 2014. Geographic information systems (GIS) methods were used to map the distribution of MRTTI alumnae across North Carolina in comparison to the distribution of IBCLCs and MRTTI training sites.GIS data sources:MRTTI alumnae location from Qualtrics survey, 2014IBCLC numbers by NC zip code from IBLCE, 2013MRTTI Clinical Site Information from Director of Training Program, 201

Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010–2011 Pregnancy Risk Assessment Monitoring System

Evidence suggests that women with postpartum depression (PPD) are at risk for early breastfeeding cessation, but previous studies have been limited by small samples. The objective of this analysis is to estimate the association between PPD symptoms and breastfeeding using a national, stratified, random sample of U.S. mothers

Prenatal Perception of WIC Breastfeeding Recommendation Predicts Breastfeeding Outcomes in Infant\u27s First Year

Objectives Promoting breastfeeding (BF) is a priority of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior research found that pregnant mothers who believed WIC recommends BF only (versus BF and formula equally OK) were more likely to initiate BF and continue through 1 month postpartum. We examine whether such mothers are more likely to continue to exclusively BF through 5 months and BF at all through the infant\u27s first year. Methods Data are from the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a longitudinal study that includes 2,649 mothers who completed prenatal interviews. Four BF outcomes were examined: (a) exclusive BF through 5 months, (b) any BF through 11 months, (c) age of the infant (in days up to 7 months) when formula is initiated, and (d) age of the infant (days up to 13 months) when mother stopped BF. We examined the associations of prenatal belief that WIC recommended BF only (yes/no) with each BF outcome using the Cox regression model to estimate the likelihood of breastfeeding outcomes over time while controlling for prenatal infant feeding intention (IFI) and socio-demographic factors. All analyses accounted for complex survey design effects. Results Of the pregnant mothers, 41% perceived that WIC recommends BF only; 59% perceived that WIC recommends BF and formula equally. Mothers who perceived WIC to recommend BF only were less likely to initiate formula by 7 months than those who perceived WIC recommended BF and formula equally [Hazard Ratio (HR) = 0.84; P \u3c 0.05], after controlling for IFI.WIC perception was a significant predictor only when IFI was not controlled for the other three BF outcomes: stopped exclusive BF through 5 months (HR = 0.83; P \u3c 0.05), stopped any BF through 11 months (HR = 0.80; P \u3c 0.01), and stopped any BF by 13 months (HR = 0.82; P \u3c 0.01). Conclusions Perception of WIC BF recommendation can be a significant predictor of BF outcomes in the infant\u27s first year, possibly by affecting BF intention. Funding Sources ITFPS-2 is funded by the Food and Nutrition Service, U.S. Department of Agriculture (USDA). Support for the study analysis was provided by the Economic Research Service, USDA CRA 58–4000-8–0038-R. Findings and conclusions are those of the authors and should not be construed to represent any official USDA or US Government determination or policy

Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study

Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC’s breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants’ perceptions of WIC’s breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the “free formula program,” and that environmental factors, such as the recent formula recall, have had an impact on participants’ infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants’ prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants’ perceptions of WIC’s position on breastfeeding

PREPARING IBLCE EXAM CANDIDATES FOR SUCCESS: Lessons Learned From the First CAAHEP-Accredited Pathway 2 Program

OBJECTIVE #1: Review characteristics of the first accredited Pathway 2 program.OBJECTIVE #2: Describe the workforce trajectories of Pathway 2-trained alumni of a year-long training program for aspiring IBCLCs.OBJECTIVE #3: Discuss how lessons learned from program alumni can be applied to support the development of future Pathway 2 programs

Clinical Interventions to Promote Breastfeeding by Latinas: A Meta-analysis

Breastfeeding duration and exclusivity among Latinas fall below recommended levels, indicating a need for targeted interventions. The effectiveness of clinical breastfeeding interventions for Latinas remains unclear

Maternal positive emotions during infant feeding and breastfeeding outcomes

Background: Major medical organizations in the U.S. recommend exclusive breastfeeding for six months, with continued breastfeeding through the first year “or longer as mutually desired by the woman and her infant.” Few studies have explored the role of maternal emotions in breastfeeding outcomes. Dr. Barbara Fredrickson’s broaden-and-build theory of positive emotions suggests that experiences of positive emotions lead to adaptive benefits by broadening one’s thought-action repertoire, allowing the accrual of personal and social resources to improve health and well-being.Aims/Purpose: To estimate the association between maternal positive emotions during infant feeding at two months and time to any and exclusive breast milk feeding cessation and overall maternal evaluation of breastfeeding at 12 months.Narrative: 185 women from a longitudinal cohort of mother-infant dyads were followed from the third trimester through 12 months postpartum. All women intended to breastfeed at least two months. We measured positive emotions during infant feeding at 2 months using the mean subscale score of the modified Differential Emotions Scale (mDES). The mDES asks the “greatest amount” 10 positive and 10 negative emotions were experienced during infant feeding over the past week using a 5-point Likert scale. We used Cox proportional hazards regression to estimate hazard ratios for time to any and exclusive breast milk feeding cessation associated with a one-unit increase in positive emotions. We also estimated the association between positive emotions and the maternal evaluation of breastfeeding at 12 months using the Maternal Breastfeeding Evaluation Scale (MBFES), which asks about agreement or disagreement with 30 statements about breastfeeding and/or expressing milk as an overall experience using a 5-point Likert scale. A one-unit increase in positive emotions at 2 months was associated with a 26% lower hazard of stopping any breast milk feeding and 42% reduced hazard of ceasing exclusive breast milk feeding (see Table 1). The association with breast milk feeding cessation was stronger where women had met their prenatal breastfeeding intention at 2 months and among Non-Hispanic White women, while the association with exclusive breast milk feeding cessation was stronger among women of color. Positive emotions at 2 months were also associated with a better maternal report of the overall breastfeeding experience at 12 months, with a stronger association among women who were breast milk feeding at 2 months. Positive emotions at 2 months were more strongly associated with the maternal enjoyment and role attainment subscale of the MBFES.Conclusions: Positive emotions during feeding at 2 months were associated with a longer time to cessation of any and exclusive breast milk feeding. More research is needed to understand trajectories of maternal emotions during infant feeding and maternal and infant outcomes associated with positive emotions