Recent Articles of Interest (Support-related)

Found via Ingenta:

Support for breastfeeding mothers: a systematic review
Paediatric & Perinatal Epidemiology, October 2003, vol. 17, no. 4, pp.
407-417(11)
Sikorski J.; Renfrew M.J.; Pindoria S.; Wade A.

Although the benefits of breastfeeding are widely accepted, the effectiveness
of different strategies to promote the continuation of breastfeeding once
initiated are less clear. The objective of this systematic review was to
describe studies comparing standard care with the provision of extra
breastfeeding support and to measure its effectiveness. Outcome measures used
were rates of cessation of any breastfeeding or exclusive breastfeeding at
chosen points in time. Measures of child morbidity and maternal satisfaction
were also used when these were reported.

Twenty eligible randomised or quasi-randomised controlled trials were
identified, involving 23 712 mother*infant pairs. Extra support had a
beneficial effect on the duration of any breastfeeding (RR [95% confidence
intervals] for stopping any breastfeeding before the last study assessment up
to 6 months 0.88 [0.81, 0.95]; 15 trials, 21 910 women). The effect was
greater for exclusive breastfeeding (RR for stopping exclusive breastfeeding
before the last study assessment 0.78 [0.69, 0.89]; 11 trials, 20 788 women).

Although the point estimates of relative risk were very similar, benefit
derived from professional support achieved statistical significance for any
breastfeeding (RR 0.89 [0.81, 0.97]; 10 trials, 19 696 women) but not for
exclusive breastfeeding (RR 0.90 [0.81, 1.01]; six trials, 18 258 women). Lay
support was effective in reducing the cessation of exclusive breastfeeding (RR
0.66 [0.49, 0.89]; five trials, 2530 women) while the strength of its effect
on any breastfeeding was less clear (RR 0.84 [0.69, 1.02]; five trials, 2224
women). Professional support in the largest trial to assess health outcomes
produced a significant reduction in the risk of gastrointestinal infections
and atopic eczema. In two trials with children suffering from diarrhoeal
illness, extra support was highly effective in increasing short-term exclusive
breastfeeding rates and reducing recurrence of diarrhoea.

This review supports the conclusion that supplementary breastfeeding support
should be provided as part of routine health service provision. There is clear
evidence for the effectiveness of professional support on the duration of any
breastfeeding although the strength of its effect on the rate of exclusive
breastfeeding is uncertain. Lay support is effective in promoting exclusive
breastfeeding although the strength of its effect on the duration of any
breastfeeding is uncertain. Evidence supports the promotion of exclusive
breastfeeding as central to the management of diarrhoeal illness in partially
breast-fed infants.


Women's Experiences of Breastfeeding in a Bottle-Feeding Culture
Journal of Human Lactation, August 2003, vol. 19, no. 3, pp. 270-277(8)
Scott J.A.; Mostyn T.

Focus group interviews were used to explore the breastfeeding attitudes and
experiences of a group of low-income Scottish women who were breastfeeding in
an environment where bottle-feeding was the cultural norm. The majority of
women interviewed had no prior exposure to breastfeeding and received little
or no support or advice for breastfeeding from family or friends. All women
were participants in a breastfeeding peer-support project, and for most the
peer volunteers represented their only source of support and guidance, outside
of that provided by health professionals. Women often went to great lengths to
avoid having to breastfeed in public, and the majority preferred to breastfeed
away from the public gaze. Despite reported increases in breastfeeding rates,
bottle-feeding remains the cultural norm in the more deprived areas of
Glasgow. Those women who do breastfeed in these areas demonstrate a high level
of commitment to breastfeeding that sets them apart from their social peers. J
Hum Lact.19(3):270-277.


Characterizing Reasons for Breastfeeding Cessation Through out the First Year
Postpartum using the Construct of Thriving
Journal of Human Lactation, August 2003, vol. 19, no. 3, pp. 278-285(8)

Kirkland V.L.; Fein S.B.

The authors examined whether 4 factors derived from the construct of
thriving‹Physical Adjustment, Infant Nutritional Status, Psychosocial
Distress, and Lifestyle Patterns‹explain reasons behind breastfeeding
cessation. Factor analysis of longitudinal 1993-1994 data showed that mother's
concern about her milk supply, wanting to leave the infant, or wanting someone
else to feed the infant were the predominant reasons cited for breastfeeding
cessation in the first 5 months. The 4 factors accounted for 97% of reasons
given in the first 2 months, 86% of reasons given in months 3 to 5, and 58% of
reasons from months 6 to 12. An additional factor‹expectation regarding
appropriate age for breastfeeding cessation‹was also important in later
months. J Hum Lact. 19(3):278-285.


Evaluation of a Lactation Support Service in a Children's Hospital Neonatal
Intensive Care Unit
Journal of Human Lactation, August 2003, vol. 19, no. 3, pp. 286-292(7)
Gonzalez K.A.; Meinzen-Derr J.; Burke B.L.; Hibler A.J.; Kavinsky B.; Hess S.;
Pickering L.K.; Morrow A.L.

Breastfeeding hospitalized infants can be difficult. The authors assessed the
effectiveness of an International Board Certified Lactation Consultants
(IBCLC) service to increase the proportion of infants given their own mother's
milk (OMM) in a children's hospital neonatal intensive care unit (NICU). The
charts of 350 randomly selected patients admitted the year before and after
implementation of the service in July 1997 were abstracted. Factors
significantly associated with infants being given OMM included infant sex,
ethnicity, length of NICU stay, and 5-minute Apgar score. After comparison of
the periods before and after pro-gram implementation, the proportion of NICU
infants ever given their OMM was found to have increased from 31% to 47% (P =
..002). This increase differed significantly in relation to infants' clinical
status and/or management (5-minute Apgar score, length of NICU stay, and age
at NICU admission) but not in relation to maternal factors. Mothers with
infants in the NICU should have access to lactation counseling. J Hum Lact.
19(3):286-292.


Evaluation of an Educational Intervention on Breastfeeding for NICU Nurses
Journal of Human Lactation, August 2003, vol. 19, no. 3, pp. 293-302(10)
Siddell E.; Marinelli K.; Froman R.D.; Burke G.

The effect of breastfeeding education on breastfeeding knowledge and attitudes
of nurses in a neonatal intensive care unit (NICU) was evaluated. NICU nurses
(intervention) and pediatric nurses (untreated control) working at a
northeastern US children's hospital participated in the pretest/posttest
design study. Both groups answered the same breastfeeding questionnaire on 2
occasions. NICU nurses completed the questionnaire the second time after
attending the education session. Outcome measures evaluated by questionnaire
items were (1) breastfeeding knowledge, (2) pro-breastfeeding attitudes, (3)
baby-focused care attitudes, and (4) nurse-focused care attitudes. Comparison
groups were similar at pretest on demographic variables and remained so
despite attrition between pretesting and posttesting. A significant increase(P
.001) occurred in NICU nurses' breastfeeding knowledge after the education
session. Findings suggest that an educational intervention has potential for
improving NICU nurses' knowledge and certain attitudes about breastfeeding but
may not alter other attitudes of interest in the desired direction.


Adolescent Mothers and Breastfeeding: Experiences and Support Needs‹An
Exploratory Study
Journal of Human Lactation, November 2003, vol. 19, no. 4, pp. 391-401(11)
Dykes F.; Moran V.H.; Burt S.; Edwards J.

The experiences and support needs of adolescent mothers who commenced
breastfeeding were elicited using focus groups and in-depth semistructured
interviews. The study took place in the North West of England, UK. The
qualitative data were analyzed using thematic networks analysis. Five themes
related to experiences emerged: feeling watched and judged, lacking
confidence, tiredness, discomfort, and sharing accountability. A further 5
themes were developed to describe the adolescents' support needs: emotional
support, esteem support, instrumental support, informational support, and
network support. These forms of support were most effective when provided
together in a synergistic way and within a trusting relationship. Key
supporters identified were the mother's mother, the partner, and the midwife
employed in a teenage pregnancy coordinator role. Health professionals need to
further exsplore the ways in which relationships may be developed and
sustained that provide the range of support required by adolescent mothers to
enable them to continue breastfeeding. J Hum Lact. 19(4):391-401.


Correlates of breastfeeding duration in an urban cohort from Argentina
Acta Paediatrica, August 2003, vol. 92, no. 8, pp. 952-957(6)
S B.; J S.; L R.; R P.; J P.; M B.

Aim: To analyse factors associated with the duration of breastfeeding in a
representative cohort of mothers and children, including socio-demographic and
cultural characteristics, breastfeeding antecedents, perinatal factors and
perinatal healthcare practices. Methods: The study was conducted in the city
of Cordoba, between 1993 and 1998. Mother-child binomials from all public and
private hospitals were asked to participate. Follow-up consisted of home
visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information was obtained on 650
healthy newborns. Cessation of breastfeeding during the first 24 mo of life
was analysed using the Kaplan-Meier method, and factors associated with
weaning were studied using Cox's proportional risk regression. Results. The
median duration of breastfeeding was 4 mo. Factors associated with weaning
we the introduction of artificial formulas within 30 d postpartum [relative
risk (RR) = 2.27; 95% confidence interval (CI) = 1.82-2.82]; breastfeeding of
a previous child for less than 6 mo (RR = 1.64; 95% CI = 1.32-2.02); delay in
the first mother-child contact for over 90 min (RR = 1.50; 95% CI =
1.17-1.93); mother's having completed primary or partially completed secondary
education (RR = 1.40; 95% CI = 1.01-1.92) or completed secondary education or
higher (RR = 1.59; 95% CI = 1.14-2.22); primiparous mother (RR = 1.39; 95% CI
= 1.12-1.74) and; the mother recalling having been breastfed for less than 6
mo (RR = 1.27; 95% CI = 1.01-1.61).

Conclusions. The purpose of strategies to promote breastfeeding should be to
eliminate inappropriate care practices, such as delay in the first
mother-child contact, as well as reducing the impact of other factors leading
to the introduction of artificial milk. Moreover, mothers need more and better
support from professionals and peers.


Perceptions of the Woman Who Breastfeeds: The Role of Erotophobia, Sexism, and
Attitudinal Variables
Sex Roles, October 2003, vol. 49, no. 7-8, pp. 379-388(10)
Forbes G.B.; Adams-Curtis L.E.; Hamm N.R.; White K.B.

Perceptions of breastfeeding women were studied in a sample of 201
predominately European American college students. Both men and women had very
positive perceptions of breastfeeding women as compared to bottlefeeding
women. As predicted, erotophobic women and men had less favorable impressions
of the breastfeeding woman than did erotophilic individuals. Men, but not
women, who scored high on Glick and Fiske's Benevolent Sexism or Hostile
Sexism scales (Glick & Fiske, 1996) had more favorable impressions of the
breastfeeding woman than did those with low scores. As predicted, this effect
was larger for Benevolent Sexism than for Hostile Sexism. No relationships
were found between impressions of breastfeeding women and the Hostility Toward
Women Scale (Lonsway & Fitzgerald, 1995) or the Trait Guilt and Moral
Standards scales (Jones, Schratter, & Kugler, 2000). The results supported
hypotheses that sexualization of the breast, discomfort with sexual stimuli,
and sexist attitudes are related to perceptions of the breastfeeding woman.


Sociodemographic and atopic factors affecting breastfeeding intention in
Chinese mothers
Journal of Paediatrics and Child Health, August 2003, vol. 39, no. 6, pp.
460-464(5)
Leung T.; Tam W.; Hung E.; Fok T.; Wong G.

The factors accounting for the low Œever breastfeeding¹ rate in Hong Kong
remain unclear. The objective of this survey was to study the intention and
planned duration of breastfeeding in Chinese women in Hong Kong, and to
investigate the sociodemographic and atopic factors affecting the intention to
breastfeed. Methods:

All Chinese mothers who were Hong Kong residents and who delivered their
babies in a University teaching hospital were given a self administered and
anonymous Chinese questionnaire within 1 day postpartum. The questionnaire
included items on sociodemographic data, the presence of allergic diseases in
the families, and the intention and planned duration of breastfeeding for
their newborn babies. Results:

A total of 1374 eligible questionnaires were collected. About one-third of
mothers were born outside Hong Kong and the majority (78%) of them were aged
between 25 and 40 years. Logistic regression revealed that only socioeconomic
factors, namely older maternal age (odds ratio (OR) 2.10, 95% confidence
interval (CI) 1.14-3.89), parity (OR 3.08, 95% CI 1.02-9.27) and higher
educational background (OR 2.87, 95% CI 1.92-4.27), significantly affected the
intention to breastfeed. In addition, mothers born outside Hong Kong and those
with first babies, had a longer intended duration of breastfeeding (P-values
0.001 and 0.033, respectively). A family history of atopic disorders in
parents or siblings did not influence the breastfeeding intention of these
Chinese mothers. Conclusion:

Several sociodemographic factors, rather than a history of atopic disorders,
of Chinese mothers in Hong Kong affected their intention to breastfeed and the
planned duration of breastfeeding.


Does Postpartum Length of Stay Affect Breastfeeding Duration? A
Population-Based Study
Birth, September 2003, vol. 30, no. 3, pp. 153-159(7)
Heck K.E.; Schoendorf K.C.; Chávez G.F.; Braveman P.


Short postpartum hospital stays may leave inadequate time for women to receive
assistance with breastfeeding. Women leaving the hospital early may also have
household responsibilities that could interfere with breastfeeding. This study
examined the relationship between postpartum length of stay and breastfeeding
cessation. Methods:

This study used data from 10,519 respondents to the California Maternal and
Infant Health Assessment (MIHA) surveys from 1999 to 2001. MIHA is an annual
statewide stratified random sample, population-based study of childbearing
women in California. Survival analysis was used to examine the relationship
between length of stay and length of time breastfeeding. Women were asked
about the number of nights their infant stayed in the hospital at birth,
whether they breastfed, and if so, the age of the child when they stopped.
Hospital stay was defined in three categories: standard (2 nights for a
vaginal delivery, 4 nights for a cesarean section), or shorter or longer than
the standard stay. Results:

Approximately 88 percent of women initiated breastfeeding. Unadjusted
predictors of breastfeeding cessation included short or long postpartum stay;
young maternal age; Hispanic, African American, or Asian/Pacific Islander
race/ethnicity; being unmarried; low income or education level; primiparity;
being born in the 50 United States or the District of Columbia; smoking during
pregnancy; and low infant birthweight. After adjustment for potential
confounders, women with a short stay remained slightly more likely to
terminate breastfeeding than women with a standard stay (relative risk, 1.11,
95% confidence interval 1.01, 1.23). Conclusion:

Women who leave the hospital earlier than the standard recommended stay are at
somewhat increased risk of terminating breastfeeding early. (BIRTH 30:3
September 2003)


Impact of Postnatal Depression on Breastfeeding Duration
Birth, September 2003, vol. 30, no. 3, pp. 175-180(6)
Henderson J.J.; Evans S.F.; Straton J.A.Y.; Priest S.R.; Hagan R.

Postnatal depression can cause adverse effects on both mother and infant, but
its impact on breastfeeding duration is poorly understood. The aim of this
study was to investigate the relationship between maternal postnatal
depression and breastfeeding duration. Methods:

A cohort of 1745 women was recruited on the postnatal wards of two large
Australian obstetric hospitals. Self-report questionnaires were completed at
recruitment, and at 2, 6, and 12 months postpartum. Breastfeeding status was
determined at each follow-up, and the Edinburgh Postnatal Depression Scale was
used to screen for symptoms of depression. Diagnostic psychological interviews
were conducted on a subsample of women at each interval. Results:

Breastfeeding was initiated by 96 percent of the participants; at 2 months 79
percent were still breastfeeding, 57 percent at 6 months, and 22 percent at 12
months. Of the 18 percent of participants diagnosed with postnatal depression,
the onset occurred before 2 months in 63 percent of cases. Median duration of
breastfeeding was 26 weeks for women with early-onset depression, 28 weeks for
women with late-onset depression, and 39 weeks for women without depression.
After adjustment for confounding factors, early cessation of breastfeeding was
found to be significantly associated with postnatal depression (adjusted
hazard ratio 1.25, 95% CI 1.03*1.52). Onset of postnatal depression occurred
before cessation of breastfeeding in most cases. Conclusions:

Postnatal depression has a significant negative impact on breastfeeding
duration. Assistance with breastfeeding issues should be included in the
management of postnatal depression.

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