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Public Health Nutrition Aug 2019To investigate whether maternal/caregiver's age, infant age (0-6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether maternal/caregiver's age, infant age (0-6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia.
DESIGN
A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle-Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done.
SETTING
All observational studies conducted in Ethiopia.ParticipantsMothers of children aged less than 2 years.ResultA total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver's age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver's age (OR=1·09; 95 % CI 0·84, 1·41).
CONCLUSIONS
There was no association between maternal/caregiver's age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum.
Topics: Adult; Age Factors; Breast Feeding; Colostrum; Ethiopia; Humans; Infant; Infant, Newborn
PubMed: 30846022
DOI: 10.1017/S1368980019000314 -
BMC Pregnancy and Childbirth Dec 2019The World Health Organization recommends that infants be exclusively breastfed until the age of six months. Breastfeeding is generally understood to mean the provision... (Review)
Review
BACKGROUND
The World Health Organization recommends that infants be exclusively breastfed until the age of six months. Breastfeeding is generally understood to mean the provision of human breastmilk to the infant by direct feeding at the breast, and interventions aimed at supporting exclusive breastfeeding are therefore targeted at this activity. However, breastfeeding is actually an umbrella term covering the provision of breastmilk to an infant by any means. Our population of interest is mothers who exclusively feed their infants indirectly using expressed breastmilk. Some research suggests that any expressing, and exclusively expressing in particular, can be a risk factor for early cessation of exclusive breastmilk provision, so we were interested to identify whether any specific support existed for exclusively expressing mothers outside of the context of premature infants and the Neonatal Intensive Care Unit setting.
METHODS
A scoping review following the Joanna Briggs Institute approach was used to explore the phenomenon of formal and informal supports in the community for exclusively expressing mothers. Searches were run across academic databases and of government websites and infant feeding support organisations. Finally, an informal internet search was run using a simple search string.
RESULTS
On analysis of results, there were no studies or articles that met the search criteria. An informal internet search linked us directly with websites and blogs that could be considered a form of support intervention. These informal results suggest that support material or programs could possibly exist in other modalities but we cannot find them in the context of this type of scoping review.
CONCLUSIONS
The results of the search corroborated what we had suspected - that exclusively expressing mothers are not specifically supported by usual channels for new parents and that it is also difficult to find acknowledgement that exclusive expression exists. The absence of results demonstrates the relevance of this study: exclusively expressing mothers are an under-served population. If we wish to strive towards achievement of World Health Organization breastfeeding goals, exclusively expressing mothers require targeted support to assist in their infant feeding experience, and there is little formal evidence of it currently being provided.
Topics: Breast Feeding; Breast Milk Expression; Female; Humans; Mothers; Social Support
PubMed: 31856734
DOI: 10.1186/s12884-019-2667-y -
Maternal & Child Nutrition Apr 2019Improving breastfeeding outcomes is a global priority; however, in the United Kingdom, continuation of breastfeeding remains low. Growing empirical evidence suggests a...
Improving breastfeeding outcomes is a global priority; however, in the United Kingdom, continuation of breastfeeding remains low. Growing empirical evidence suggests a free breast pump service might be an acceptable and feasible incentive intervention to improve breastfeeding outcomes and reduce heath inequalities. To inform intervention development, we conducted an online survey with women recruited via social media using snowball sampling. Data were analysed descriptively (closed questions) with qualitative thematic analysis (free text). The survey was completed by 666 women, most of whom had recently breastfed and used a breast pump. Participants agreed that free pump hire (rental/loan; 567 women; 85.1%) or a free pump to keep (408; 61.3%) should be provided. Free text comments provided by 408 women (free pump) and 309 women (free hire) highlighted potential benefits: helping women to continue breastfeeding; express milk; overcome difficulties; and pump choice. Concerns are possible effect on breast milk supply, reduced breastfeeding, pumps replacing good support for breastfeeding, and pump hire hygiene. Personal and societal costs are important issues. Some suggested a pump service should be for low-income mothers, those with feeding difficulties or sick/preterm infants. A one-size service would not suit all and vouchers were proposed. Some suggested fees and deposits to prevent waste. To our knowledge, this is the first study reporting views about the acceptability of providing a free breast pump hire service. Mothers support and wish to have a say in breast pump service development. Future evaluations should address impact on feeding outcomes, professional support, hygiene for hired pumps, and costs.
Topics: Adult; Breast Feeding; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Milk, Human; Mothers; Surveys and Questionnaires; United Kingdom; Young Adult
PubMed: 30381867
DOI: 10.1111/mcn.12745 -
BMJ Open Jan 2023There is an urgent need to improve breast feeding rates for Australian First Nations (Aboriginal and Torres Strait Islander) infants. We explored breast feeding outcomes...
Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study.
OBJECTIVES
There is an urgent need to improve breast feeding rates for Australian First Nations (Aboriginal and Torres Strait Islander) infants. We explored breast feeding outcomes of women having a First Nations infant at three sites that introduced a culturally specific continuity of midwife care model.
DESIGN
Women having a First Nations infant booking for pregnancy care between March 2017 and November 2020 were invited to participate. Surveys at recruitment and 3 months post partum were developed with input from the First Nations Advisory Committee. We explored breast feeding intention, initiation, maintenance and reasons for stopping and factors associated with breast feeding.
SETTING
Three tertiary maternity services in Melbourne, Australia.
PARTICIPANTS
Of 479/926 eligible women approached, 343 (72%) completed the recruitment survey, and 213/343 (62%) the postnatal survey.
OUTCOMES
Primary: breast feeding initiation and maintenance. Secondary: breast feeding intention and reasons for stopping breast feeding.
RESULTS
Most women (298, 87%) received the culturally specific model. Breast feeding initiation (96%, 95% CI 0.93 to 0.98) was high. At 3 months, 71% were giving 'any' (95% CI 0.65 to 0.78) and 48% were giving 'only' breast milk (95% CI 0.41 to 0.55). Intending to breast feed 6 months (Adj OR 'any': 2.69, 95% CI 1.29 to 5.60; 'only': 2.22, 95% CI 1.20 to 4.12), and not smoking in pregnancy (Adj OR 'any': 2.48, 95% CI 1.05 to 5.86; 'only': 4.05, 95% CI 1.54 to 10.69) were associated with higher odds. Lower education (Adj OR 'any': 0.36, 95% CI 0.13 to 0.98; 'only': 0.50, 95% CI 0.26 to 0.96) and government benefits as the main household income (Adj OR 'any': 0.26, 95% CI 0.11 to 0.58) with lower odds.
CONCLUSIONS
Breast feeding rates were high in the context of service-wide change. Our findings strengthen the evidence that culturally specific continuity models improve breast feeding outcomes for First Nations women and infants. We recommend implementing and upscaling First Nations specific midwifery continuity models within mainstream hospitals in Australia as a strategy to improve breast feeding.
Topics: Infant; Female; Pregnancy; Humans; Victoria; Midwifery; Breast Feeding; Cohort Studies; Milk, Human; Hospitals
PubMed: 36635038
DOI: 10.1136/bmjopen-2022-066978 -
Nicotine & Tobacco Research : Official... Mar 2020National and international organizations have done an excellent job of advocating and promoting breast feeding for all mothers. This study assessed to what extent an... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
National and international organizations have done an excellent job of advocating and promoting breast feeding for all mothers. This study assessed to what extent an intervention increased delivery of cessation assistance to breast-feeding mothers who smoke.
METHODS
Data were collected between April and October 2015 in five US states as part of a cluster randomized controlled trial in 10 pediatric practices. Practices were randomized to the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care control arms. Mothers were asked about their smoking status and breast-feeding history during a screening interview upon exiting the practice and eligible mothers who agreed to participate in an enrollment interview were asked if they received smoking cessation assistance during their child's visit. Mothers with a child 1 year old and younger were included in the analyses.
RESULTS
Current breast feeding was associated with a reduced likelihood of current smoking (adjusted odds ratio [aOR] = 0.38, 95% confidence interval [95% CI] = 0.25 to 0.57) and a greater likelihood of quitting smoking (aOR = 2.33, 95% CI = 1.29 to 4.21) after controlling for known confounders. Mothers who concurrently smoked and breast-fed were more likely to be asked about smoking (66.7% vs. 28.6%, p = .01), advised to quit (61.1% vs. 21.4%, p < .01), prescribed nicotine replacement therapy (50.0% vs. 0%, p < .001), and enrolled into the quitline (27.8% vs. 0%, p < .01) at CEASE practices compared to control practices.
CONCLUSION
Breast-feeding mothers were less likely to be current smokers and more likely to have recently quit smoking. Among mothers who continue to smoke and breast feed, the CEASE intervention enhances delivery of smoking cessation assistance.
IMPLICATIONS
Breast feeding and eliminating infants' exposure to tobacco smoke are important protective factors for serious pediatric health risks including sudden infant death. This study shows that breast feeding was positively associated with desirable tobacco control outcomes, specifically that breast feeding was associated with a lower likelihood of smoking among ever smokers and a greater likelihood of recently quitting smoking. This is also the first study to look specifically at delivery of smoking cessation assistance to breast-feeding mothers seen at pediatric offices and demonstrates the effectiveness of delivering evidence-based smoking cessation assistance to them in this context.
TRIAL REGISTRATION
www.ClinicalTrials.gov (identifier NCT01882348).
Topics: Adult; Behavior Therapy; Breast Feeding; Female; Humans; Infant; Infant, Newborn; Mothers; Pediatrics; Smoking; Smoking Cessation; Tobacco Smoke Pollution; Tobacco Use Cessation Devices; Young Adult
PubMed: 30521040
DOI: 10.1093/ntr/nty247 -
Public Health Nutrition Mar 2015To assess the relationships between maternal breast-feeding intention, attitudes, self-efficacy and knowledge at 7 months' gestation with exclusive or full... (Observational Study)
Observational Study
OBJECTIVE
To assess the relationships between maternal breast-feeding intention, attitudes, self-efficacy and knowledge at 7 months' gestation with exclusive or full breast-feeding at 3 months postpartum.
DESIGN
Prospective cohort study with structured home interviews during pregnancy and 3 months after delivery.
SETTING
Two rural sub-districts of Kishoreganj district, Bangladesh.
SUBJECTS
Mother-infant dyads.
RESULTS
Over 80 % of 2178 pregnant women intended to exclusively breast-feed (EBF). Maternal positive attitudes, self-efficacy and knowledge about breast-feeding were positively associated with EBF intention (all P<0.05). All mothers except one reported initiating breast-feeding and 99.6 % of children were still breast-fed at 3 months. According to 24 h dietary recalls, we categorized 985 (45.2 %) infants as EBF at 3 months (47.8 % among mothers with EBF intention; 31.7 % among mothers with no EBF intention; P<0.05) and 551 (25.3 %) infants as predominantly breast-fed at 3 months (24.2 % among mothers with EBF intention; 30.8 % among mothers with no EBF intention; P<0.05). Prenatal EBF intention was associated with EBF (OR=1.48, 95 % CI 1.14, 1.91) and with full breast-feeding (OR=1.34, 95 % CI 1.04, 1.72) at age 3 months. EBF at age 3 months was not associated with maternal breast-feeding knowledge, attitudes or self-efficacy.
CONCLUSIONS
Despite widespread expressed maternal EBF intention and universal breast-feeding initiation, prevalence of both exclusive and full breast-feeding at 3 months remains lower than WHO recommendations. EBF intention predicts breast-feeding behaviours, suggesting the importance of prenatal counselling to improve infant feeding behaviours.
Topics: Adolescent; Adult; Bangladesh; Breast Feeding; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Infant, Newborn; Intention; Middle Aged; Postpartum Period; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Rural Population; Self Efficacy; Young Adult
PubMed: 25327700
DOI: 10.1017/S1368980014000937 -
International Breastfeeding Journal Nov 2020In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive...
BACKGROUND
In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector.
METHODS
This formative research was conducted during July-September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0-12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted.
RESULTS
The main themes of qualitative exploration were knowledge and experience of breastfeeding; structural barriers (home and workplace); consequences of inadequate breastfeeding; and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination.
CONCLUSION
As RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers' ability to use breast milk could help to promote infant health and help women remain in the workforce.
Topics: Bangladesh; Breast Feeding; Female; Humans; Infant; Infant, Newborn; Lactation; Male; Mothers; Qualitative Research; Urban Population; Women, Working; Work
PubMed: 33160366
DOI: 10.1186/s13006-020-00338-0 -
International Breastfeeding Journal May 2022Expression and storage of breastmilk is a strategy that ensures continued breast milk consumption in the event of temporary separation of an infant from the mother....
BACKGROUND
Expression and storage of breastmilk is a strategy that ensures continued breast milk consumption in the event of temporary separation of an infant from the mother. However, many studies show that working mothers are unable to exclusively breastfeed for six months successfully. Working mothers are forced to wean early because of minimal support at the workplace, lack of knowledge on breast milk expression and lack of storage facilities. The 2017 Kenya Health Act mandates employers to provide lactation rooms for facilitation of breast milk expression in support of the lactating mother. This study analyses the knowledge attitude and practice of breast milk expression among working women in Kenya.
METHODS
This was a cross sectional study done between December 2018 and February 2019. Study participants were 395 working women with infants aged six months and below, attending well baby clinics in two large public hospitals in Nairobi Kenya. A structured questionnaire with open and closed ended questions was used to establish the knowledge and practice while a Likert scale was used to explore attitudes of the mothers towards expression and storage of breast milk.
RESULTS
Overall satisfactory knowledge on breast milk expression and storage was attained by only 34% of working mothers. Eighty four percent positively agreed that expression and storage of breast milk would help them achieve six months of exclusive breastfeeding. Challenges experienced were breast pain and cumbersome nature of expressing milk. Only 41% (161) were expressing breast milk either regularly or occasionally. The most common reason (24.7%) for expressing milk was to enable someone else feed the baby when they were at work. Most mothers (77%) expressed at home as the workplace did not seem to provide adequate equipment to facilitate breastmilk expression and storage.
CONCLUSIONS
There is a substantial knowledge gap on expression and storage of breast milk. Working mothers have a good attitude towards attainment of exclusive breast milk feeding through expression of breast milk. The workplace does not have adequate facilities to support expression and storage of breast milk.
Topics: Breast Feeding; Breast Milk Expression; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Kenya; Lactation; Mothers
PubMed: 35501894
DOI: 10.1186/s13006-022-00469-6 -
BMC Pregnancy and Childbirth Jan 2022Breast milk feeding has numerous benefits for women and infants. Positive maternal experiences with breast milk feeding impacts exclusivity, duration, and maternal...
BACKGROUND
Breast milk feeding has numerous benefits for women and infants. Positive maternal experiences with breast milk feeding impacts exclusivity, duration, and maternal mental health. Most research focuses on women feeding directly at the breast. Some women elect to feed exclusively expressed milk to their healthy, term infants rather than feed directly at the breast. Little is known about what constitutes a positive experience among this population. Therefore, the aim of this study was to explore women's experiences of exclusive expression (EE).
METHODS
Interviews were conducted via Microsoft Teams to collect qualitative data from a purposive sample of 21 women practicing EE. Interviews were analyzed for themes.
RESULTS
Three themes: Unseen and Unheard, Doing it My Way, and Getting into the Groove, and 8 subthemes: Breast is Best, Missed Opportunities for Healthcare Provider Support, Fighting for it, What Works for Us, A Sense of Control, Preparation, Tricks of the Trade, and Making it Manageable were identified. Despite challenges, including a lack of support from healthcare providers and a lack of acknowledgement as breastfeeding mothers, exclusive expression offered participants a method to continue breast milk feeding in a way that they found to be satisfying.
CONCLUSION
This study provides insight into experiences of exclusive expression that clinicians can use to improve their support of breast milk feeding during perinatal encounters. Societal pressure to feed from the breast may have negative emotional consequences for women electing to exclusively express. There is a need for more information and support for breast milk expression from healthcare providers along with a reframing of how breast milk feeding is discussed and promoted.
Topics: Breast Feeding; Breast Milk Expression; Female; Humans; Mothers; Qualitative Research
PubMed: 35062895
DOI: 10.1186/s12884-022-04388-6 -
Breastfeeding Medicine : the Official... Sep 2017More than 85% of contemporary lactating women in the United States express their milk at least sometimes. Some produce milk exclusively through pumping. We characterized...
BACKGROUND
More than 85% of contemporary lactating women in the United States express their milk at least sometimes. Some produce milk exclusively through pumping. We characterized women who pumped but never fed at the breast and compared their infant feeding practices with those of women who fed at the breast with or without pumping.
SUBJECTS AND METHODS
Study participants were those delivered at Ohio State University Wexner Medical Center in 2011 and completed a questionnaire at 12 months postpartum (n = 478). We used bivariate and multivariate approaches (survival analysis) to compare women who pumped but never fed at the breast with women who fed at the breast with or without pumping.
RESULTS
Women (n = 33, 6.9%) who pumped but never fed at the breast comprised a diverse group but were more likely to have delivered preterm and were of lower socioeconomic status on average. They initiated pumping and formula feeding earlier (median = day 1 after delivery) and were more likely to report difficulty making enough milk compared with women who fed at the breast with or without pumping. They had much shorter total duration of milk production (adjusted hazard ratio = 3.3, 95% confidence interval: 2.1, 5.2) after controlling for clinical and sociodemographic confounders.
CONCLUSIONS
Pumping without feeding at the breast is associated with shorter milk feeding duration and earlier introduction of formula compared with feeding at the breast with or without pumping. Establishing feeding at the breast, rather than exclusive pumping, may be important for achieving human milk feeding goals.
Topics: Adult; Bottle Feeding; Breast Feeding; Breast Milk Expression; Choice Behavior; Educational Status; Feeding Behavior; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Infant, Newborn; Lactation; Maternal Age; Mothers; Ohio; Parity; Retrospective Studies; Smoking; Social Class; Socioeconomic Factors; Young Adult
PubMed: 28727931
DOI: 10.1089/bfm.2017.0025