Wellbeing of breastfeeding women in Australia and New Zealand during the covid‐19 pandemic: A cross‐sectional study

During the COVID‐19 pandemic, breastfeeding women have experienced restricted access to support, placing them at increased risk of mental health concerns and limited breastfeeding assistance. This study investigated the effect of the pandemic on feeding choices and maternal well-being amongst breastfeeding mothers living in Australian and New Zealand. We conducted a cross-sectional online survey that examined feeding methods, maternal mental wellbeing, worries, challenges, and positive experiences during the pandemic. Most women were exclusively breastfeeding (82%). Partial breastfeeding was associated with perceived low milk supply and longer pregnancy duration during the pandemic. Reduced mental health and wellbeing was associated with lower levels of family functioning, increased perceived stress, and perinatal anxiety. Longer pregnancy duration during the pandemic was associated with lower mental health wellbeing scores, while higher perceived stress scores were reported for regions with higher COVID‐19 infection rates and women with perceived low milk supply. Women reported that the pandemic resulted in less pressure and more time for family bonding, while worries about the pandemic, family health, and parenting challenges were also cited. Mental health concerns of breastfeeding women appear to be exacerbated by COVID‐19, highlighting a critical need for access to mental health and broader family support during the pandemic

Longitudinal changes in wellbeing amongst breastfeeding women in Australia and New Zealand during the COVID-19 pandemic

The COVID-19 pandemic has impacted new mothers’ wellbeing and breastfeeding experience. Women have experienced changes in birth and postnatal care and restricted access to their support network. It is unclear how these impacts may have changed over time with shifting rates of infection and policies restricting movement and access to services in Australia and New Zealand. This study investigated the longitudinal effect of the COVID-19 pandemic on breastfeeding and maternal wellbeing in Australia and New Zealand. Mothers (n = 246) completed an online survey every 4 weeks for 6 months that examined feeding methods, maternal mental wellbeing, worries, challenges, and positive experiences during the pandemic. Mothers maintained high full breastfeeding rates at 4 months (81%) which decreased to 37% at 6 months. Perceived low milk supply contributed to the earlier cessation of full breastfeeding. Poor infant sleep was associated with stress, perinatal anxiety, mental wellbeing, and breastfeeding status. Although mothers initially reported that lockdowns helped with family bonding and less pressure, prolonged lockdowns appeared to have adverse effects on access to social networks and extended family support. Conclusion: The results highlight the changing dynamic of the pandemic and the need for adaptable perinatal services which allow mothers access to in-person services and their support network even in lockdowns. Similarly, access to continuous education and clinical care remains critical for women experiencing concerns about their milk supply, infant sleep, and their own wellbeing. What is Known: The COVID-19 pandemic and lockdown restrictions have significantly affected perinatal mental health, disrupted maternal services, and subsequent breastfeeding. What is New: In Australia and New Zealand, breastfeeding women experienced challenges to their mental wellbeing, sleep, and breastfeeding, which was likely exacerbated over time by the pandemic. Lockdowns, while initially beneficial for some families, became detrimental to maternal support and wellbeing

Risk Factors for Low Milk Production

Numerous factors not consistently identified in pregnancy are linked with decreased breastfeeding exclusivity and durations. These factors may be considered in three domains: the anatomical, metabolic, and psychosocial domains. As fundamental research into lactation has increased, it is now often possible to identify or speculate the mechanisms by which these factors potentially reduce milk production. The first domain describes the anatomical characteristics of the breast, including intrinsic factors such as hypoplasia (underdevelopment), which may have a genetic component and can be masked by breast augmentation surgery. Hypoplasia has long been associated with the inability to make a full milk production that satisfyies the infant’s needs, although it is not possible to predict a woman’s 24-h milk production so that appropriate complementary feeds can be advised. Extrinsic causes such as breast reduction surgery impact the volume of glandular tissue, thereby reducing the synthetic capacity of the breast. Whereas nipple piercings may damage milk ducts, obstructing milk flow from the breast and thereby reducing milk supply via the autocrine pathway. Various maternal metabolic disorders (intrinsic) comprise the second domain, which includes conditions such as gestational diabetes mellitus, type 1 and 2 diabetes, polycystic ovarian syndrome (often undiagnosed), and hypothyroidism. The aberrant levels of hormones associated with these disorders, such as insulin, are also implicated in breast development, raising the possibility of reduced mammary growth in pregnancy and, consequently, milk production. Much more research is needed in this area, not only to understand mechanisms by which lactation is impacted but also to identify the women at risk of reduced lactation capacity. The third and final domain includes psychosocial issues such as short intended breastfeeding durations, a lack of breastfeeding support, and maternal anxiety and depression. With respect to anxiety and depression, their association with reduced breastfeeding is likely multifaceted, encompassing mood and the potential biochemical changes associated with these states, such as lower levels of circulating oxytocin and higher cortisol levels. Possessing a knowledge of the negative impacts of the intrinsic and extrinsic factors within the maternal anatomical, metabolic, and psychosocial domains provides the impetus for antenatal lactation screening. The antenatal identification of risk factors enables anticipatory guidance and education during pregnancy, as well as early postpartum intervention should breastfeeding issues occur

Development of Breastfeeding Behaviours in Preterm Infants

Breastfeeding is particularly important for vulnerable preterm infants as it provides protection from infections and reduces newborn mortality. However, preterm infants are often too immature to breastfeed after birth and may have medical conditions that require admission to the neonatal nursery. The published literature on the development of preterm feeding skills has focused mostly on bottle feeding. In order to better support breastfeeding after preterm birth, there is a need for evidence on the development of breastfeeding skills in preterm infants. The aim of this study was to examine breastfeeding skill development in a group of infants born at 25–33 weeks’ gestation. Infants were assessed during weekly monitored breastfeeds from 33 weeks corrected gestational age (CGA) using the Preterm Infant Breastfeeding Behaviour Scale (PIBBS), and milk transfer was measured. Mothers rated PIBBS items—rooting, areolar grasp, latch to the breast, sucking, longest sucking burst and swallowing—and clinical staff performed test weights. Pearson correlation was used to assess changes in PIBBS scores items over time and associations between total PIBBS score and milk transfer volume. Total PIBBS scores at 33, 34 and 35 weeks’ CGA were compared between groups of infants born at t-test. Our cohort consisted of 60 preterm mother–infant dyads recruited from the neonatal nurseries at King Edward Memorial Hospital between February 2015 and February 2016. A positive trend was found between increasing CGA and higher ratings for six PIBBS items: rooting (R2 = 0.08, F (1, 164) = 13.9, p R2 = 0.11, F (1, 164) = 21.0, p R2 = 0.14, F (1, 164) = 27.5, p R2 = 0.14, F (1, 164) = 27.1, p R2 = 0.17, F (1, 164) = 32.3, p R2 = 0.14, F (1, 163) = 26.1, p R2 = 0.214, F (1, 164) = 44.8, p +6 weeks’ gestation had similar PIBBS scores at 33 weeks’ CGA (9.2 ± 3.6 vs. 9.5 ± 4.1, p = 0.83) and lower scores at 34 weeks’ CGA (9.2 ± 3.4 vs. 11.7 ± 4.3, p = 0.036) and 35 weeks’ CGA (12.3 ± 3.1 vs. 14.9 ± 3.5, p = 0.031). The development of preterm breastfeeding skills advances from 33 weeks CGA with wide inter-individual variation and slower progression observed in those born < 30 weeks’ gestation. Therefore, an individualised approach to anticipatory guidance regarding breastfeeding progression during the neonatal nursery stay is needed. Findings from this study can contribute to the formation of breastfeeding information resources for clinical staff and parents of preterm infants

Screening for Lactation Risk Factors in Pregnancy

The early cessation of exclusive or any level of breastfeeding is often attributed to low milk supply [...

Maternal Breast Growth and Body Mass Index in Relation to Milk Production

Low milk production poses a substantial challenge to exclusive and continued breastfeeding, which affects 10–15% of lactating mothers [...

Human milk expression technologies: an evaluation of efficacy and comfort of hands-free, in-bra, breastmilk collection pump set

Summary: Background &amp; Aims: To improve convenience and maximize flexibility whilst pumping, wearable pumps have been designed however, their performance have not been evaluated. This study aimed to develop the protocol and evaluate the efficacy and comfort of a new hands-free, in-bra, breastmilk collection pump set (IBCPS) connected to a personal use double electric breast pump. Methods: In this cross-sectional observational study 23 participants in established lactation (1–6 months postpartum) completed one pumping session with an IBCPS where both breasts were pumped simultaneously (n = 46) using the participant's maximum comfortable vacuum for a period of 15 minutes of expression after milk ejection. Milk output and removal parameters were measured together with maternal comfort. Participants completed a 24-h milk production profile to allow percentage of available milk removed (PAMR) during the pumping session to be calculated. Results: The amount of milk expressed from each breast (n = 46) was 71.7 ± 40.7 g and from both breasts combined (n = 23) was 143.3 ± 62.0 g. For each breast, PAMR was 73.6 ± 32.1 % and the rate of milk removal was 4.9 ± 2.6 g/min. Participants rated pumping with IBCPS as comfortable. Conclusions: Applying an IBCPS resulted in efficient and effective breast emptying without considerable compromise in comfort. This study has established a protocol to objectively determine the efficacy of wearable pumps

Human Milk Expression Technologies: An Evaluation of Mobility and Comfort Perception of a Hands-Free, In-Bra, Breastmilk Collection Pump Set

Wearable pumps have been designed to improve convenience and maximize flexibility whilst pumping and are reported to benefit lactating health professionals when they return to work [...

A Comparison of the Efficacy and Comfort of Traditional and a Hands-Free, In-Bra Breastmilk Collection Pump Sets

Breastfeeding women who pump their milk report that pumping is time-consuming [...