ALLATTAMENTO AL SENO: VALIDAZIONE DEL BREASTFEEDING ASSESSMENT SCORE RIDOTTO, SU UN GRUPPO DI PUERPERE ITALIANE.

TITLE. Breastfeeding: validation of a reduced Breastfeeding Assessment Score (BAS) in a group of Italian women. AIM AND OBJECTIVE. To assess the accuracy of a reduced Breastfeeding Assessment Score (BAS) in a group of Italian women; the reduced BAS considers only 5 of the 8 original BAS items studied, those not indicating a pathology. BACKGROUND. The WHO and many Professional Organizations recommend exclusive breastfeeding for the first 6 months of life because of its many benefits for mother and child. A prognostic approach that identifies mothers at increased risk of early breastfeeding cessation is needed in order to provide preventive support. The BAS, elaborated in Kansas, is useful to this approach. DESIGN. This is a descriptive, prospective study. This study involves two Italian hospitals. METHOD. We included healthy Italian mothers who gave birth from July 7, 2008 to January 15, 2009. The exclusion criteria on the convenience sample were: non-Italian nationality, birth under 36 wks and twin birth. The authors calculated a reduced BAS (\u201creduced\u201d because the original 8 items studied by Hall, were reduced to 5) 48 hours after birth. After 4 weeks a structured follow-up telephone interview was carried out: the primary outcome was breastfeeding cessation (including mixed feeding). RESULTS. We recruited 386 women, with 6 lost during follow-up. Out of 380 women, 127 (33.4%) stopped breastfeeding. With a cut off point of 8, the reduced BAS sensitivity was 52.0%, which increased to 77.9% by using a cut-off point of 9. We also calculated a modified BAS with different age categories, which is adequate based on the Italian situation: in this case sensitivity was 70.1%. This study suggests that a reduced BAS with a different cut-off point or modified with a different age classification is useful in identifying Italian mothers who will discontinue breastfeeding, as in both cases sensitivity does increase. RELEVANCE TO CLINICAL PRACTICE. Italian midwives could use this modified BAS to identify mothers at increased risk of early breastfeeding cessation needing special support

What information is available to women regarding coronavirus and childbirth in Italy? A mixed-methods exploration of the web during the COVID-19 lockdown

Problem: The world is fighting against the COVID-19 pandemic and an infodemic; Italy is one of the most severely affected countries. Background: The internet represents a popular source of health information. In Italy, its use amongst pregnant women and new mothers has increased during the lockdown. No research has examined the nationally accessible information related to childbirth in these unprecedented circumstances. Aim: To explore online information accessible to Italian users concerning childbirth and coronavirus-related issues. Methods: A mixed methods exploration of the web was conducted involving searches on Google, peer discussion forums and midwifery association webpages. Data were analysed both quantitatively and qualitatively. A cross-consultation analysis of themes was performed to identify macro categories of information. Findings: A total of 720 results from free searches, 635 interventions from 97 forums and 68 posts from four midwifery association webpages were analysed. Informative/divulging sources were the most prevalent in Google; pregnancy-related topics appeared more in discussion forums and midwifery association webpages. ‘Prevention’; ‘risks and outcomes’; ‘users’ experiences’ and ‘reorganisation of maternity services’ represent the cross-consultation categories of information. Discussion: Google emerges as the main contributor to the infodemic; national systems of alert and ranking of web sources are needed. Women’s pragmatic needs are more likely to be addressed by peer-discussion forums and midwifery association webpages during and after COVID-19. Conclusion: This is the first study to investigate childbirth-related web information during COVID-19 in Italy; findings may impact on education, research and practice

Ecologia e nascita

Aim and objective. To assess the accuracy of a reduced Breastfeeding Assessment Score (BAS) in a group of Italian women; the reduced BAS considers only 5 of the 8 original BAS items studied, those not indicating a pathology. Background. The WHO and many Professional Organizations recommend exclusive breastfeeding for the first 6 months of life because of its many benefits for mother and child. A prognostic approach that identifies mothers at increased risk of early breastfeeding cessation is needed in order to provide preventive support. The BAS, elaborated in Kansas, is useful to this approach. Design. This is a descriptive, prospective study. This study involves two Italian hospitals. Method. We included healthy Italian mothers who gave birth from July 7, 2008 to January 15, 2009. The exclusion criteria on the convenience sample were: non-Italian nationality, birth under 36 wks and twin birth. The authors calculated a reduced BAS (\u201creduced\u201d because the original 8 items studied by Hall, were reduced to 5) 48 hours after birth. After 4 weeks a structured follow-up telephone interview was carried out: the primary outcome was breastfeeding cessation (including mixed feeding). Results. We recruited 386 women, with 6 lost during follow-up. Out of 380 women, 127 (33.4%) stopped breastfeeding. With a cut off point of 8, the reduced BAS sensitivity was 52.0%, which increased to 77.9% by using a cut-off point of 9. We also calculated a modified BAS with different age categories, which is adequate based on the Italian situation: in this case sensitivity was 70.1%. This study suggests that a reduced BAS with a different cut-off point or modified with a different age classification is useful in identifying Italian mothers who will discontinue breastfeeding, as in both cases sensitivity does increase. Relevance to clinical practice. Italian midwives could use this modified BAS to identify mothers at increased risk of early breastfeeding cessation needing special support. Key words: Breastfeeding Assessment Score, Breastfeeding cessation, Breastfeeding suppor

Mother's difficulties in breastfeeding: a review of qualitative studies

QUESTION: What difficulties lead mothers early abandoning exclusive breastfeeding despite WHO and UNICEF recomanded breastfeeding to at least six months postpartum as best practice for mothers and babies? AIM: This paper reviews the qualitative research literature about difficulties mothers may experience in setting up and maintaining breastfeeding until their babies are six months old. METHOD: An online qualitative literature search was conducted in Pubmed, Embase and CINHAL database. The search strategy included the following keywords: breastfeeding, exclusive breastfeeding, difficulties/problems, qualitative article/research. Studies not exclusively qualitative, meta-synthesis and reviews were excluded. RESULTS: From the 1990-2010 search, in twenty-two articles, four themes emerged about mothers\u2019 difficulties in breastfeeding: \u2022 personal difficulties (demographic, biophysical and psychological factors); \u2022 social difficulties (marital status and income level; coming back to work; social context; social and familiar support; father\u2019s involvement in neonatal care); \u2022 cultural difficulties (presence of a \u201cbreastfeeding culture\u201d; woman\u2019s body perception; maternal or breastfeeding stereotypes); \u2022 healthcare difficulties (organization of health services during pregnancy, birth and the postpartum period; healthcare professional support). CONCLUSION: The duration of exclusive breastfeeding to at least six months postpartum is influenced by many personal, social, cultural factors and by socio-sanitary maternity services. It is clear from women\u2019s accounts that all these aspects cannot be reduced to single factors acting in isolation; many of them tend to be experienced in combination. So, only their mutual influence can enlighten women\u2019s experiences during breastfeeding difficulties. Healthcare professionals can use the study findings to better identify mothers who risk early breastfeeding cessation and to better design future professional interventions; social and political institutions can use the review results in order to guarantee social and structural conditions to breastfeeding mothers by reducing those barriers who prevent them to exclusively breastfeeding their babies for the first six months of life

Exploring the mother's perception of latching difficulty in the first days after birth : an interview study in an Italian hospital

OBJECTIVES: to explore Italian mothers' perception of latching difficulty in the first days postpartum. Latching difficulty is the only qualitative item included in the Breastfeeding Assessment Score (BAS) that has proven to be a valid instrument to identify women at risk of early breast-feeding cessation. DESIGN AND SETTING: a phenomenologic-hermeneutic study was conducted at the Mangiagalli Clinic, Milan, Italy. PARTICIPANTS: fifteen women who received a BAS <8 (indicating an early breast-feeding cessation risk) were interviewed before discharge, and later by phone, for member checking. FINDINGS: six main themes emerged from the interviews: (1) Breast feeding can be difficult due to both the mother and newborn, and encountered problems are mainly physical. (2) Women have developed different strategies to overcome latching difficulties. (3) Early breast feeding, even if difficult, is mostly related to positive feelings. (4) Breast-feeding sustains the child-mother relationship. (5) Mothers have already developed constructive theories about human colostrum, breast milk and artificial milk. (6) Receiving integrated health-care support and education is fundamental to overcome early breast-feeding problems. CONCLUSIONS: the interviews suggest that although mothers experience difficulties during early breast feeding, positive feelings seem to prevail over the negative ones, and mothers have already developed strategies to overcome their latching problems. Receiving support is fundamental, but this must be consistent among health-care professionals. IMPLICATIONS FOR PRACTICE: when evaluating the BAS item 'latching difficulty', midwives should consider that difficulties are primarily related to physical problems. Furthermore, to sustain lactation, mothers should be helped to elicit their experience of early breast feeding, as it can be extremely satisfying, even when difficulties in latching the babies occur

Latching difficulty during breastfeeding: What do Italian mothers say, about their experience? A qualitative study

Introduction Many professional organizations recommend breastfeeding for the first 6 months due to the numerous benefits it has for mother and child. The mother\u2019s breastfeeding experiences in the early postpartum period, are crucial in deciding to continue it. It is important to identify, in the first days after childbirth, women who send messages that are likely to early stop breastfeeding. Many women have said to have breastfeeding difficulties in the first days after birth. Several studies1-4 have explored the motivation of early breastfeeding cessation but little is known on what "breastfeeding difficulty" really means for women. Aim of the study Our goal was to gain a more in-depth understanding of Italian women\u2019s experiences of breastfeeding difficulties, in the early post natal period. Methods The women who received a Breastfeeding Assessment Score5 (BAS) less than 8, and reported \u201clatching difficulties\u201d, were invited to participate in the study. With purposive sampling we recruited 15 women, 48-72 hours after childbirth. We conducted semi-structured interviews which were tape-recorded and verbatim transcribed. The transcripts were read and analyzed using the Grounded Theory method. Results "Latching difficulty" is related to issues including both mother\u2019s and infant\u2019s difficulties. Nipple-pain and infant\u2019s sleepiness were the most reported difficulties. In spite of these difficulties, the sensation related to breastfeeding was \u201chappiness\u201d when the baby sucked the breast, but concern and anxiety were common too. The women reported more impediment in overcoming the breastfeeding difficulty when there was an idealization of breastfeeding, during pregnancy. Conclusion This study enriches the theoretical framework in understanding the dynamics that can contribute to early failure of breastfeeding in Italy. Practical relevance Understanding the meaning of the item \u201clatching difficulty\u201d consents to a more correct interpretation of the BAS5 by the Italian midwives and allows a more accurate identification of the mothers who need support and education during breastfeeding Research implications Since this is a qualitative study, more research is needed to understand the \u201clatching difficulty\u201d in the Italian environment and in other culture

Breastfeeding : validation of a reduced breastfeeding assessment Score in a group of Italian women

Aim and objective. To assess the accuracy of a reduced Breastfeeding Assessment Score in a group of Italian women; the reduced Breastfeeding Assessment Score considers only five of the eight original Breastfeeding Assessment Score items studied, those not indicating a pathology. Background. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life because of its many benefits. A prognostic approach that identifies mothers at increased risk of early breastfeeding cessation is needed to provide preventive support. The Breastfeeding Assessment Score is useful to this approach. Design. This is a descriptive, prospective study. This study involves two Italian hospitals. Method. We included healthy Italian mothers who gave birth from 7 July 2008\u201315 January 2009. The exclusion criteria on the convenience sample were: non-Italian nationality, birth under 36 weeks and twin birth. The authors calculated a reduced Breastfeeding Assessment Score (\u2018reduced\u2019 because the original eight items studied by Hall, were reduced to five) 48 hours after birth. After 4 weeks a structured follow-up telephone interview was carried out: the primary outcome was breastfeeding cessation. Results. We recruited 386 women, with six lost during follow-up. Out of 380 women, 127 (33\uc64%) stopped breastfeeding. With a cut off point of 8, the reduced Breastfeeding Assessment Score sensitivity was 52\uc60%, which increased to 77\uc69% by using a cut-off point of 9. We also calculated a modified Breastfeeding Assessment Score with different age categories, which is adequate based on the Italian situation: in this case sensitivity was 70\uc61%. This study suggests that a reduced Breastfeeding Assessment Score with a different cut-off point or modified with a different age classification is useful in identifying Italian mothers who will discontinue breastfeeding, as in both cases sensitivity does increase. Relevance to clinical practice. Italian midwives could use this modified Breastfeeding Assessment Score to identify mothers at increased risk of early breastfeeding cessation

Esperienza di ricerca per la validazione del reduced breastfeeding score sulla popolazione italiana

Background/Problema: I benefici dell\u2019allattamento al seno materno, sulla salute dei neonati, delle madri, della societ\ue0, sono evidenti1. Nonostante questo, la pratica dell\u2019allattamento materno \ue8 spesso interrotta precocemente. Una survey condotta dell\u2019Istituto Nazionale di Statistica Italiano ha mostrato che l\u201981,1% delle madri allatta il proprio figlio al momento della dimissione ospedaliera ma che tale pratica si riduce del 20% entro il terzo mese di vita del bambino. Un recente report ha indagato la prevalenza dell\u2019allattamento al seno, nelle donne della regione Lombardia2. A 48 ora dal parto, il 95,6% delle madri allatta il proprio figlio, ma la prevalenza precipita al 67,5% entro il primo trimestre di vita. Tali dati confermano la criticit\ue0 delle prime settimane dopo il parto per l\u2019abbandono dell\u2019allattamento al seno. Numerosi studi hanno evidenziato che il supporto fornito dai professionisti della salute subito dopo il parto e nei primi giorni dopo la dimissione ospedaliera, \ue8 fondamentale per la protezione dell\u2019allattamento al seno. Considerata l\u2019importanza dell\u2019allattamento materno e le limitate risorse di cui si dispone, riuscire ad individuare precocemente le donne a rischio di interrompere l\u2019allattamento, \ue8 auspicabile per poter mirare il sostegno alla pratica. Con questa finalit\ue0 nel 20023 \ue8 stato elaborato in Kansas, uno score chiamato Breastfeeding Assessment Score (BAS), con una significativit\ue0 prognostica con un valore di cut-off di 8. Obbiettivi: validare il BAS sulla popolazione di puerpere italiane. Materiali e metodi: studio descrittivo, prospettico, bicentrico ( Fondazione IRCCS C\ue0 Granda Ospedale Maggiore Policlinico e Ospedale San Gerardo dei Tintori). Con campionamento di convenienza sono state incluse donne intenzionate ad allattare, sane, con gravidanza singola, fisiologica, con parto avvenuto a termine, con neonato sano. Al momento della dimissione, i ricercatori hanno attribuito alle donne incluse il BAS e sono hanno rilevato alcuni aspetti demografici e clinici relativi alla gravidanza e al parto. Dopo un mese dal parto tutte le donne sono state ricontattate telefonicamente. Durante il follow-up si \ue8 rilevato come la madre stava allattando in quel momento (allattamento esclusivo, predominante, complemetato o artificiale). In caso di allattamento complementato o artificiale, \ue8 stato chiesto il motivo dell\u2019interruzione dell\u2019allattamento esclusivo. E stato inoltre chiesto in che giornata si \ue8 interrotto l\u2019allattamento esclusivo. Metodi statistici: La validit\ue0 del BAS \ue8 stata valutata attraverso l\u2019analisi della sensibilit\ue0, della specificit\ue0 e dell\u2019area sottesa alla curva ROC. E\u2019 stata valutata l\u2019associazione del BAS e di altre variabili con la cessazione dell\u2019allattamento esclusivo utilizzando il test del Chi quadro, e l\u2019interruzione dell\u2019allattamento nel tempo attraverso la curva di sopravvivenza di Kaplan-Meier. Le variabili che all\u2019analisi univariata sono risultate associate all\u2019interruzione dell\u2019allattamento e le variabili di interesse a priori, sono state successivamente analizzate con il modello di regressione logistica. Le analisi sono state eseguite usando il software Stata 11. Risultati: Hanno preso parte allo studio 386 donne. E\u2019 stato attribuito un BAS > 8 in 267 donne (69,2 %) e un BAS a 8 in 200 casi (specificit\ue0 79,1 %). Nelle 127 donne che avevano interrotto l\u2019allattamento il BAS fu < a 8 in 66 casi (sensibilit\ue0 52 %). Poich\ue9 le donne incluse nello studio aveva un et\ue0 pi\uf9 alta rispetto alle donne del Kansas, \ue8 stato calcolato un punteggio BAS utilizzando delle diverse categorie di et\ue0. Per il BAS modificato l\u2019area sottesa alla curva ROC fu di 0,70. Assumendo un punto di cut-off di 8, il BAS modificato con le nuove categorie di et\ue0 ha dimostrato una specificit\ue0 di 57,3% e una sensibilit\ue0 di 70,1 %. Dopo regressione logistica multipla, l\u2019area sottesa alla curva ROC \ue8 stata di 0,84. Discussione/Conclusione: I risultati della ricerca hanno confermato il trend nazionale di prevalenza di allattamento al seno e l\u2019et\ue0 media delle partorienti italiane2. Questo studio valida il BAS - ridotto a 5 variabili e modificato nelle categorie di et\ue0 delle donne, utilizzando un punto di cut-off di 8 - come un utile strumento nell\u2019identificare le nutrici che smetteranno precocemente di allattare e con questo lavoro ci si propone di fornire al personale addetto all\u2019assistenza, uno strumento utile per mirare l\u2019efficacia e l\u2019efficienza del supporto alla donna nutrice