Breastfeeding after Gestational Diabetes: Does Perceived Benefits Mediate the Relationship?

Introduction. Breastfeeding is recognized as one of the best ways to decrease infant mortality and morbidity. However, women with gestational diabetes mellitus (GDM) may have breastfeeding barriers due to the increased risk of neonatal and pregnancy complications. While the prevalence of GDM is increasing worldwide, it is important to understand the full implications of GDM on breastfeeding outcomes.The current study aims to investigate the (1) direct effect of GDM on breastfeeding duration and (2) indirect effect of GDM on breastfeeding duration through perceived benefits of breastfeeding. Methods. Prospective cohort data from the Infant Feeding and Practices Study II was analyzed (=4,902). Structural equation modeling estimated direct and indirect effects. Results. Perceived benefits of breastfeeding directly influenced breastfeeding duration ( = 0.392, ≤ 0.001). GDM was not directly associated with breastfeeding duration or perceived benefits of breastfeeding. Similarly, GDM did not have an indirect effect on breastfeeding duration through perceived benefits of breastfeeding. Conclusions. Perceived benefits of breastfeeding are an important factor associated with breastfeeding duration. Maternal and child health care professionals should enhance breastfeeding education efforts

Factors Influencing Breastfeeding in a Hospital Setting

Breastfeeding is promoted across the globe as the optimum method of infant feeding (World Health Organization, WHO, 2003). Though there is a plethora of published benefits of breastfeeding for baby and mother, breastfeeding rates are below the national goal of 75% for Healthy People 2010 during early postpartum and considerably lower at six months and at one year (Li et al., 2005; HHS, 2000). Arkansas is significantly below the national average and goals, with only 60% of mothers ever breastfeeding versus 74% nationally (Centers for Disease Control and Prevention, CDC, 2008). To meet these goals nationally and on a state level, it is important to examine the factors associated with a mother’s choice of breastfeeding. Part I of this study examined the relationship between breastfeeding at discharge and the mother’s initial feeding preference, method of delivery, time of birth, birth-to-breast time, and any formula supplementation. It also identified which factor had the strongest relationship with rates of breastfeeding upon hospital departure. Part II of this study examined hospital nurses’ attitudes, knowledge, and confidence about breastfeeding instruction as related to their self-reported assistance with and promotion of breastfeeding in the past year. Results: Exclusive breastfeeding at discharge was related to type and time of delivery, birth–to-breast time, and use of formula supplementation. Knowledge and attitude scores did not yield significant correlations with the assistance and promotion of breastfeeding, though a weak positive correlation was noted between confidence in breastfeeding promotion and the nurses\u27 assistance and promotion of breastfeeding

The reasons why women with small for gestational age babies stop breastfeeding : a thesis presented in partial fulfilment of the requirements for the Master of Arts in Midwifery at Massey University

There has been a multitude of research literature on breastfeeding benefits, incidence and duration of breastfeeding, characteristics of women who breastfeed and formula feed, and variables associated with breastfeeding initiation and success in the 'general' breastfeeding population. Unfortunately there has been very little written about breastfeeding in women who deliver small for gestational age (SGA) babies. The literature has demonstrated that women with SGA babies have different characteristics to women in the general breastfeeding population as illustrated in the adjacent literature review. The literature review, which accompanies this thesis, has highlighted the multiple advantages associated with breastfeeding, which may be particularly beneficial for SGA babies. Whether women delivering SGA babies have different breastfeeding experiences, or reasons for discontinuing breastfeeding, however has never been investigated. The research presented in this thesis is part of a randomised-controlled trial entitled "The effect of educational information on the duration of breastfeeding in small for gestational age babies". Only one arm of this larger study has been analysed due to the restraints of a 75-point thesis. The full program of study is in progress. The primary aim of this arm was to determine why women with small for gestation age babies stop breastfeeding. Other influences on breastfeeding success were also investigated to determine if these external influences were statistically significant. The findings from this research project have demonstrated that women with SGA babies have the same breastfeeding concerns as women in the general breastfeeding population. The most commonly cited reason for stopping breastfeeding were concerns about 'not enough milk'. Forty four percent of the women cited the midwife as being the most 'valuable' support with their breastfeeding experience. Overall the women with SGA babies had very good breastfeeding rates at 3 and 6 months postnatally compared with the general breastfeeding population statistics. This is a credit to the midwives caring for these women and babies and may also be related to the fact that term SGA babies have been undernourished in utero and can often be hungry babies with 'catching up' to do. These research findings also support the idea that the introduction of supplementary bottles administered on the postnatal wards can have a detrimental effect on future breastfeeding success. However, small for gestational age infants are at increased risk of hypoglycaemia and supplemental feeding may be necessary if the infant is feeding poorly or shows evidence of hypoglycaemia. Any strategies that can improve the breastfeeding duration for SGA infants can result in a wide range of health benefits. The adjacent literature review demonstrates that breastfeeding is the best form of infant feeding and may be even more so for small term babies

Identifying Barriers and Supports to Breastfeeding in the Workplace Experienced by Mothers in the New Hampshire Special Supplemental Nutrition Program for Women, Infants, and Children Utilizing the Total Worker Health Framework

Variations in the barriers and contributors to breastfeeding across industries have not been well characterized for vulnerable populations such as mothers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Our study used the Total Worker Health Framework to characterize workplace factors acting as barriers and/or contributors to breastfeeding among women participating in the New Hampshire WIC. Surveys were collected from WIC mothers (n = 682), which asked about employment, industry, and workplace accommodation and supports related to breastfeeding in the workplace. We found workplace policy factors supporting breastfeeding (i.e., having paid maternity leave, other maternity leave, and a breastfeeding policy) varied by industry. Women in specific service-oriented industries (i.e., accommodation and retail) reported the lowest rates of breastfeeding initiation and workplace supports for breastfeeding and pumping. Further, how a woman hoped to feed and having a private pumping space at work were significantly associated with industry, breastfeeding initiation, and breastfeeding duration. A substantial portion of women reported being not sure about their workplace environment, policies, and culture related to breastfeeding. Additional studies with larger sample sizes of women participating in WIC are needed to further characterize the barriers to breastfeeding associated with specific industries

Intrapartum epidural analgesia and breastfeeding: a prospective cohort study

BACKGROUND Anecdotal reports suggest that the addition of fentanyl (an opioid) to epidural analgesia for women during childbirth results in difficulty establishing breastfeeding. The aim of this paper is to determine any association between epidural analgesia and 1) breastfeeding in the first week postpartum and 2) breastfeeding cessation during the first 24 weeks postpartum. METHODS A prospective cohort study of 1280 women aged > or = 16 years, who gave birth to a single live infant in the Australian Capital Territory in 1997 was conducted. Women completed questionnaires at weeks 1, 8, 16 and 24 postpartum. Breastfeeding information was collected in each of the four surveys and women were categorised as either fully breastfeeding, partially breastfeeding or not breastfeeding at all. Women who had stopped breastfeeding since the previous survey were asked when they stopped. RESULTS In the first week postpartum, 93% of women were either fully or partially breastfeeding their baby and 60% were continuing to breastfeed at 24 weeks. Intrapartum analgesia and type of birth were associated with partial breastfeeding and breastfeeding difficulties in the first postpartum week (p < 0.0001). Analgesia, maternal age and education were associated with breastfeeding cessation in the first 24 weeks (p < 0.0001), with women who had epidurals being more likely to stop breastfeeding than women who used non-pharmacological methods of pain relief (adjusted hazard ratio 2.02, 95% CI 1.53, 2.67). CONCLUSION Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks. Although this relationship may not be causal, it is important that women at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support.Christine Roberts is supported by a National Health and Medical Research Council (NHMRC) of Australia Public Health Practitioner Fellowship and Siranda Torvaldsen is supported by a NHMRC Australian Research Training Fellowship. The cohort study was supported by a project grant from The Canberra Hospital Private Practice Fund. Additional funding was provided by The Canberra Hospital Auxiliary, the Nurses' Board of the Australian Capital Territory, and the Australian Capital Territory Department of Health & Community Care

Prevalence of exclusive breastfeeding and its determinants in first 6 months of life: A prospective study

Background: Exclusive breastfeeding for first 6 months of life is recommended under Infant and Young Child Feeding practices in India. The objective of present study was to estimate the prevalence of exclusive breastfeeding during first 6 months of life of babies and to identify factors that interfere with the practice in the study area. Methods: A prospective cohort of 462 women who delivered at maternity unit of Government Medical College & Hospital, Rajkot, which is a tertiary care centre for the district, was studied. Data collection was done at hospital as well as during home visits of babies at 1, 3 and 6 months. Factors related to cessation of breastfeeding were analyzed using univariate, bivariate and multivariate analysis. Results: All 462 mothers reported breastfeeding their newborns. Prevalence of exclusive breastfeeding reported at 3 months was 97% which declined to 62% by 6 months of age of infants. Bivariate analysis revealed no significant association between interruption of exclusive breastfeeding before 6 months of age and various demographic, socioeconomic, maternal and infant characteristics. Multivariate analysis by logistic regression demonstrated no association between discontinuation of exclusive breastfeeding and socioeconomic status, maternal education and maternal age, number of antenatal visits, maternal employment and initiation of breastfeeding after delivery. Conclusion: Exclusive breastfeeding prevalence rate found higher than at national level indicating better feeding practices in these part of India. Also, factors classically considered as supportive for breastfeeding had shown no association with breastfeeding pattern in present study

Birth and breastfeeding events : the influence of birth on breastfeeding duration : an exploratory research study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Midwifery, Massey University

A retrospective exploratory methodology was used to examine the influence perinatal events had on breastfeeding duration measured at four months postpartum. A self-reporting questionnaire and examination of obstetric records provided the quantitative data for 68 normal vaginal birth women and 85 Caesarean section women. Nonparametric Pearson's Chi-square goodness of fit test was used to measure statistical significance. Almost 88% (87.6%) of the respondents were breastfeeding four months following birth. This was 86.8% of normal birth women and 88.2% of Caesarean section women. Sixty-four percent of infants were exclusively breastfeeding and 11% fully breastfeeding four months after birth. Prior breastfeeding was the only event or experience found to be significantly statistically associated with type of birth and breastfeeding duration. A marginally significant statistical relationship was found between type of Caesarean section and breastfeeding at four months postpartum. Highly significant statistical relationships were identified between type of birth and: time of first cuddle, concomitant skin-to-skin contact, time of first breastfeed, supplementary feeding in hospital, and receiving help in hospital. A significant statistical relationship was identified between type of birth and having a breastfeeding problem in hospital, and a marginally significant statistical relationship between type of birth and 'rooming in'. Other events that were expected and identified as highly significant statistically were: multiparity and having breastfed before, having a breastfeeding problem in hospital and receiving help, type of birth and time in hospital, and breastfeeding at four months postpartum and satisfaction. There was a marginally significant statistical relationship between breastfeeding at four months postpartum and type of caesarean section. This studies finding that there was no difference in breastfeeding rates at four months for either sub-sample of women warrants further exploration

Effectiveness of CenteringPregnancy on Breast-Feeding Initiation Among African Americans: A Systematic Review and Meta-analysis

While breastfeeding initiation rates for African American mothers are low, an innovative model of group prenatal care, CenteringPregnancy, holds promise to increase breastfeeding rates. The aim of this systematic review and meta-analysis was to examine the effects of CenteringPregnancy versus individual prenatal care on breastfeeding initiation among African American mothers. Using a systematic approach and PRISMA guidelines, 4 electronic databases were used to search the literature. English-language studies, comparing CenteringPregnancy and individual prenatal care, including African American participants, and specifying breastfeeding initiation as an outcome were screened for inclusion. Study strength and quality were assessed and 7 studies were systematically reviewed and meta-analyzed. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 53% (95% confidence interval = 29%-81%) (n = 8047). A subgroup analysis of breastfeeding initiationamong only African American participants was performed on 4 studies where data were available. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 71% (95% confidence interval = 27%-131%) (n = 1458) for African American participants. CenteringPregnancy is an effective intervention to increase breastfeeding initiation for participants, especially for African Americans. To close the racial gap in breastfeeding initiation, high-quality research providing specific outcomes for African American participants in CenteringPregnancy are needed

Breastfeeding education: where are we going? A systematic review article

Background: UNICEF (United Nations International Children’s Emergency Fund) and WHO estimate that if all babies were breastfed for at least the first six months of their lives, the rate of morbidity and malnutrition would sig-nificantly decrease all over the world. In this view, these two organizations promoted a worldwide campaign for breastfeeding, creating the Baby Friendly Hospital Initiative (BFHI) that encourages good practices for the promotion of breastfeeding in hospitals. The aim of our study was to review the available evidence regarding the positive effects of breastfeeding, in order to suggest to most appropriate strategy to support it. Methods: The main databases including Scopus, PubMed, MEDLINE, Google scholar and Science Direct were researched to obtain the original papers related to breastfeeding education. The main terms used to literature search were "Breastfeeding education", Breastfeeding support", and “Breastfeeding healthcare policy”. The timeframe in-cluded the obtained articles was from 1980 to 2015. Results: Our analysis confirms that healthcare providers play a pivotal role in education and encouraging mothers to begin and continue breastfeeding. In this view, the adequate training of healthcare providers seems to be mandatory in order to support this practice. Moreover, adequate facilities are needed in order to promote and support breastfeeding. Conclusion: Considering the available evidence, breastfeeding should be supported among all the mothers. Based on the positive data emerging from the public awareness campaign in different Countries of the world, we strongly en-courage an accurate training for doctors and midwives and the implementation of adequate facilities in order to sup-port breastfeeding

Valuing Breastfeeding: Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates

Alongside a randomized controlled trial testing the effectiveness of offering a cash transfer scheme (shopping vouchers) to mothers in areas with low breastfeeding rates, qualitative interviews were conducted with health care professionals delivering the scheme to explore their experiences. Health care professionals (n = 34; mainly midwives and health visitors) were interviewed in depth. Transcripts from recorded interviews were analyzed using a Framework Analysis approach. There was widespread acceptance of the scheme by health care professionals, with prior concerns regarding bribery and coercion being quickly allayed. Health care professionals reported that the scheme fitted in well with their routine ways of promoting and endorsing breastfeeding. They described their experiences of women’s positive reaction toward the scheme and how the scheme encouraged breastfeeding and gave breastfeeding higher value. Health care professionals reported that the incentives helped them engage women and promote and support breastfeeding in areas with low breastfeeding rates