Breastfeeding Experiences of Mothers Using Telehealth at One and Four Weeks Postpartum

Research demonstrates that breastfeeding provides many health benefits for both mothers and infants. However, many mothers stop breastfeeding in the early postpartum period due to problems such as sore nipples, engorgement, mastitis, and insufficient milk supply. Lactation support is associated with increased breastfeeding duration. However, in underserved rural and urban areas some mothers lack access to lactation support. Telehealth technology has not been used to address this problem in the U.S., but may be an alternative means to provide mothers with lactation support. The purpose of the parent study was to evaluate the feasibility and reliability of telehealth methods for assessing and providing lactation support in women’s homes over the first four weeks after birth. The purpose of this ancillary study was to identify the breastfeeding experiences of mothers at one and four weeks postpartum, and to determine if telehealth enhanced breastfeeding support. Seven mother‐baby dyads were recruited from the maternity unit of a 600 bed Midwestern university‐affiliated hospital and a free standing birthing center. Data were collected using videoconferencing and face to face home visits to compute LATCH breastfeeding assessment scores. The Breastfeeding Experience Scale (BES) was administered via the telephone at one and four weeks postpartum. Data analyses included descriptive statistics and narrative analysis. At one week, the most frequent experiences of mothers were feeling tired/fatigued, (85.8%), followed by baby’s reluctance to nurse due to sleepiness (85.7%), and sore nipples (85.7%). On a 5‐point scale, the most severe experiences were sore nipples (moderate, 3) and engorgement (mild, 2). At week four, the most frequent experiences were mothers feeling tired/fatigued (85.8%), mothers feeling tense and overwhelmed (85.8%), and baby’s reluctance to nurse due to fussiness (71.5%). The most severe experiences were feeling tired/fatigued (moderate, 3), sore nipples, baby’s reluctance to nurse due to sleepiness and fussiness, leaking breasts, and feeling tense and overwhelmed (mild, 2). The majority of mothers (n=6) reported they had an improved breastfeeding experience and that they had a decrease in breastfeeding problems because of their telehealth experience. At four weeks, 5 were exclusively breastfeeding. In conclusion, telehealth may be an important tool in breastfeeding assessment and support and more research in this area is needed.University of Kansas, Bachelor of Science Nursing Honors Progra

Exploring barriers to exclusive breastfeeding among adolescent Latina women

American adolescent mothers typically have low rates of exclusive breastfeeding. Currently, Hispanics make up the largest ethnic group in the U.S., have high fertility rates, bear their children at younger ages, and also have low rates of exclusive breastfeeding. These factors put adolescent Latina mothers at higher risk for not exclusively breastfeeding; however, there is a lack of research about exclusive breastfeeding in this population. This study examines the attitudes and barriers to exclusive breastfeeding in a sub-sample of adolescent Latinas who are part of an ongoing larger qualitative exploration of barriers to exclusive breastfeeding. Pender’s health promotion model frames the study in which enrollment is currently taking place in a large city in the Midwest. An exploratory descriptive approach is being performed using semi-structured, in-person interviews conducted in either English or Spanish with the use of the ARSMA-II to identify participants’ acculturation levels. Tape-recorded interviews are transcribed verbatim. Spanish transcripts are translated to English for analysis. Inductive content analysis is being performed by hand. For this sub-study, the results are then interpreted in relation to Pender’s Health Promotion Model in a case analysis fashion. One 16 and one 17-year-old mother comprised this case analysis. Acculturation scores suggest that the younger teen is more acculturated than the older teen. Findings were consistent with concepts of Pender’s model. The largest difference between the two cases was the amount of school support each received, with one teen getting ample support while lack of support hindered the other in providing breast milk. Findings are consistent with previous adolescent breastfeeding research regarding support.UNIVERSITY OF KANSAS SCHOOL OF NURSING BACHELOR OF SCIENCE IN NURSING HONORS PROGRAMSELF REPORTED HEALTH PROMOTION BEHAVIORS OF INDIVIDUALS WITH PSYCHIATRIC DISABILITIES IN A WEIGHT LOSS INTERVENTION Biethman, E Hamera, E PATIENT SATISFACTION FOR THE ADULTS WITH DOWN SYNDROME SPECIALTY CLINIC Bowman, S Peterson, M BUILDING STUDENT RESOURCES FOR THE KANSAS CENTER FOR NURSING SCHOLARSHIP & LEADERSHIP Feighny, M Teel, C EXPLORING BARRIERS TO EXCLUSIVE BREASTFEEDING AMONG ADOLESCENT LATINA WOMEN Hansen, L L Wambach, K FAMILY CAREGIVER STRAIN AND RESIDENT DISTRESS IN THE DEMENTIA POPULATION OF NURSING HOME FACILITIES Harris, B Bott, M J COMPLEMENTARY THERAPY/CARE TO RELIEVE PEDIATRIC CANCER-THERAPY RELATED SYMPTOMS IN THAILAND Shanberg, R Williams, P D Piamjariyakul,

The Perceived Behavioral Control of Breastfeeding Among Pregnant Adolescents and Its Relation to Postpartum Breastfeeding Difficulties

Submitted to the School of Nursing in partial fulfillment of the requirements for the Nursing Honors Program.Despite a large body of evidence supporting breastfeeding as best for infants and mothers, rates still fall short of the Healthy People 2010 Goals. The initiation and duration rates of adolescents are even lower, despite the fact that benefits for this population may be greater. Breastfeeding can be explained using the theory of planned behavior and its concepts of attitude, subjective norm, perceived behavioral control, and intentions. The purpose of this secondary analysis (N = 289) was 1) to determine the relationship between prenatal breastfeeding control (PBC), prenatal feeding intentions and breastfeeding at birth; and 2) among those who initiate breastfeeding, the relationship between PBC and breastfeeding concerns and difficulties at three and six weeks postpartum. Data from a randomized control trial was obtained from a questionnaire measuring theory concepts upon enrollment and at 32 – 36 weeks gestation. Upon delivery, 69% of the teens (n = 201) initiated exclusive or partial breastfeeding. All breastfeeding participants were contacted by phone at 3 and 6 weeks postpartum, and completed the Breastfeeding Experiences Scale. Data analyses included descriptive statistics, Pearson or Spearman correlations, Chi‐Square analysis, and narrative content and frequency analysis. PBC perceptions were significantly related to prenatal intentions to breastfeed (r = .54, p = .01), but not significantly related to three and six week breastfeeding problem severity perceptions. Among those who breastfed at birth, mean prenatal PBC levels were higher among those who continued breastfeeding at three weeks (t = ‐2.3 (163), p = .026). Weaning decisions in the early postpartum period were based on physical issues, but included psychosocial issues as time progressed. In conclusion, the TPB is a useful model for predicting intentions to breastfeed in this vulnerable population.University of Kansas Medical Center University of Kansas School of Nursing, Bachelor of Science in Nursing Honors Progra

Clinical lactation practice: 20 years of evidence

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue

Modeling the Influence of Early Skin-to-Skin Contact on Exclusive Breastfeeding in a Sample of Hispanic Immigrant Women

Using data from a longitudinal study of breastfeeding in Hispanics, this study evaluated the influence of early skin-to-skin contact (SSC) on initiation and sustained exclusive breastfeeding (EBF) at 1 month postpartum. Two-thirds of the women in the sample participated in early SSC. At discharge, over half of the women were EBF; this proportion decreased to one-third at 1 month postpartum. Controlling for demographic and clinical variables in the model, participation in early SSC was associated with a greater than sevenfold increase in the odds of EBF at discharge (p = .005) but was not predictive of EBF at 1 month post-discharge (p = .7). Younger maternal age and increased prenatal infant feeding intention were associated with an increased likelihood of EBF across both timepoints. Promoting early SSC may help with initiation of EBF, while further breastfeeding support may be needed to maintain EBF following discharge for this vulnerable population

momHealth: A Feasibility Study of a Multi-behavioral Health Intervention for Pregnant and Parenting Adolescent Mothers

Introduction. In 2016, 209,809 babies were born to mothers 15 -19 years of age, for a live birth rate of 20.3 per 1,000 in this age group. Many health issues surround adolescent mothers and their infants, many  which can be addressed through behavioral change. We examined feasibility and acceptability of momHealth, a Multiple Health Behavior Change (MHBC) intervention focused on breastfeeding, healthy eating/active living, and depression prevention among pregnant and parenting adolescents. Methods. We used a one-group quasi-experimental longitudinal design. Nine iPad-delivered education modules, text messaging, and virtual group and individual support were provided for 12 weeks, beginning at 32 weeks of pregnancy with follow-up to 3 months postpartum. Data were collected at three home visits and ten postpartum weekly and biweekly online surveys. Results. Although recruitment and attrition presented challenges, six participants enrolled; all were pregnant with their first child, single, and had a mean age of 17.7 years (SD = 1.4). Intervention participation ranged from 59% to 91% for intervention components and three peer support groups were held. Intervention feasibility was supported by reports of clear and relevant content, reasonable time burden, iPad ease of use, and acceptable intervention length. Data collection was reported as convenient and non-burdensome, but diet recalls and activity monitoring challenged some.    Conclusions. This was the first MHBC research in adolescent pregnant women to improve breastfeeding outcomes, healthy eating/active living, and depression prevention. Findings demonstrated strengths and challenges of the interventions and methods, support feasibility and acceptability of momhealth, and informed a pilot randomized trial.

Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women\u27s Health Initiative

Background: Stroke is the third leading cause of death among US Hispanic and non-Hispanic black women aged 65 and older. One factor that may protect against stroke is breastfeeding. Few studies have assessed the association between breastfeeding and stroke and whether this association differs by race and ethnicity. Methods and Results: Data were taken from the Women\u27s Health Initiative Observational Study with follow-up through 2010; adjusted hazard ratios for stroke subsequent to childbirth were estimated with Cox regression models accounting for left and right censoring, overall and stratified by race/ethnicity. Of the 80 191 parous women in the Women\u27s Health Initiative Observational Study, 2699 (3.4%) had experienced a stroke within a follow-up period of 12.6 years. The average age was 63.7 years at baseline. Fifty-eight percent (n=46 699) reported ever breastfeeding; 83% were non-Hispanic white, 8% were non-Hispanic black, 4% were Hispanic, and 5% were of other race/ethnicity. After adjustment for nonmodifiable potential confounders, compared with women who had never breastfed, women who reported ever breastfeeding had a 23% lower risk of stroke (adjusted hazard ratio=0.77; 95% confidence interval 0.70-0.83). This association was strongest for non-Hispanic black women (adjusted hazard ratio=0.52; 95% confidence interval 0.37-0.71). Further, breastfeeding for a relatively short duration (1-6 months) was associated with a 19% lower risk of stroke (adjusted hazard ratios=0.81; 95% confidence interval 0.74-0.89). This association appeared stronger with longer breastfeeding duration and among non-Hispanic white and non-Hispanic black women (test for trend P \u3c 0.01). Conclusions: Study results show an association and dose-response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted

A test of a breastfeeding intention and outcome model.

While there has been considerable research effort expended on determining correlates of breastfeeding initiation and duration, less systematic testing of theory has been done. For health care professionals to provide interventions to increase breastfeeding incidence and duration, it is essential that substantive theory be developed and tested. A correlational descriptive design with causal modeling methodology was utilized. The purposes of the research were three-fold: (1) to examine differences between women who breastfed and bottle-fed; (2) to test Ajzen's theory of planned behavior with a group of 138 breast and bottle-feeding mothers; and (3) to test a model based on the theory to increase explanation in behavior in terms of early experiences and duration of breastfeeding (n = 148). Measures based on the theory, Cuson's Attitudes on Breastfeeding Scale, the Breastfeeding Experience Scale, Hughes Breastfeeding Support Scale, and a demographic questionnaire were used for data collection. Women were contacted in their final weeks of pregnancy, shortly following birth, and for those breastfeeding, four to six weeks postpartum. Data analysis included: use of descriptive, parametric, and nonparametric statistics to examine group differences; psychometric testing; and multiple linear and logistic regression, as well as residual analysis, to test the models. Results indicated significant differences between the two groups of women on major demographic variables and some model variables. The theory of planned behavior reduced to its predecessor, the theory of reasoned action, and with respecification resulted in a model containing additional variables; previous breastfeeding experience and family income. Fifty-two percent of the variance in prenatal intentions was explained by the first stage variables and twelve percent of the variance in actual behavior was predicted by intentions. The test of the intention and outcome model was partially supportive of the theoretical hypotheses. Model respecification resulted in a model that explained twenty-three percent of the variance in intentions, ten percent of the variance in breastfeeding experience perceptions, and nine percent of the variance in breastfeeding duration. Theoretical and methodological issues, suggestions for clinical practice, and recommendations for future research are presented

The effect of lactation consultant contact on early breastfeeding problems

This quasi-experimental study, using Orem's Nursing Systems Construct as a theoretical base, was conducted to determine the effects of education and support given by a lactation consultant on early breastfeeding problem incidence and resolution. Mothers were recruited in the hospital and interviewed by telephone two to three weeks postpartum to determine problem incidence, rate of resolution, perception of the problems' interference, self-care measures, and support network characteristics. The study sample consisted of 16 first-time breastfeeding mothers placed in naturally occurring experimental (n = 7) and control (n = 9) groups. The groups did not differ significantly in age, education, ethnicity, mode of birth, or presence of a support person in the home. The groups did not differ significantly in number of problems, problem resolution length, or perceptions regarding problems' severity. A significant difference was found in the use of formula supplements, with the control group using supplementation more than the experimental group