Factors associated with exclusive breastfeeding 2 to 4 weeks following discharge from a large, urban, academic medical center striving for baby-friendly designation

Substantial evidence documents the superiority of breastfeeding for mothers and breastmilk for babies. Although the American Academy of Pediatrics and the U.S. Healthy People 2010 initiative promote breastfeeding, current breastfeeding rates often fall short of recommendations. This study determined factors associated with exclusive breastfeeding 2 to 4 weeks following discharge from a large, urban, academic medical center striving for Baby-Friendly designation. Results indicated that mothers who breastfed within the first hour of birth (61%) were significantly more likely to be exclusively breastfeeding 2 to 4 weeks after discharge. Incorporating care practices that include a number of the "Ten Steps to Successful Breastfeeding," as recommended by the Baby-Friendly Hospital Initiative, may increase the duration of exclusive breastfeeding after discharge.     

Evaluation of a Practice-Development Initiative to Improve Breastfeeding Rates

The benefits of breastfeeding for infant, mother, family, and community are well recognized, and increasing breastfeeding rates is considered an important health-promotion strategy. Improving breastfeeding knowledge and practice among individuals caring for breastfeeding women is considered an important aspect of this strategy. The practice-development initiative described in this article aimed to improve hospital-based breastfeeding rates through the implementation of The Ten Steps to Successful Breastfeeding. The initiative included the development and implementation of an education program aimed at changing and improving breastfeeding practices. The program was evaluated in three ways: changes in breastfeeding rates at hospital discharge; client preparation for breastfeeding and satisfaction during the postnatal period; and staff knowledge and skills.     

Introduction: the coalition for improving maternity services:

The history of the Coalition for Improving Maternity Services as part of a global effort to promote normal birth is described. The principles underlying the Mother-Friendly Childbirth Initiative are presented, the Ten Steps of Mother-Friendly Care are identified, and the evidence basis for the Ten Steps is introduced.     

Methods: the coalition for improving maternity services:

In this article, the details of the methods used to determine the evidence basis of the Ten Steps of Mother-Friendly Care are presented and discussed.     

Step 9: discourages nonreligious circumcision of the newborn: the coalition for improving maternity services:

Step 9 of the Ten Steps of Mother-Friendly Care discourages nonreligious circumcision of the newborn. The rationale for compliance and systematic review are presented.     

Step 4: provides the birthing woman with freedom of movement to walk, move, assume positions of her choice: the coalition for improving maternity services:

Step 4 of the Ten Steps of Mother-Friendly Care insures that women have the freedom to walk, move, and assume positions of their choice during labor and birth. The rationales and the evidence in support of this step are presented.     

Commentary: the coalition for improving maternity services:

A consumer advocate, two childbirth educators, and a certified nurse-midwife each provide commentary on the effectiveness of and potential uses for the Evidence Basis for the Ten Steps of Mother-Friendly Care.     

Report from the Country of Georgia: Protecting and Promoting Breastfeeding through Regulation of Artificial-Feeding Marketing Practices

This paper highlights the southwest Asian country of Georgia's experience in creating efforts to protect and promote breastfeeding and to implement the International Code of Marketing of Breast-milk Substitutes. Since 1994, the country of Georgia (of the former Soviet Union) has successfully implemented the Baby-Friendly Hospital Initiative. In 1997-1998, Georgia conducted a study throughout the country's various regions to evaluate compliance with the International Code of Marketing of Breast-milk Substitutes. The research demonstrated numerous violations of the code by various companies and confirmed the necessity of ongoing activities to promote implementation of the code. Due to the great effort of Georgia's Ministry of Health and the International Baby-Food Action Network [IBFAN] Georgian group called "Claritas," the law titled "On Protection and Promotion of Breastfeeding and Regulation of Artificial Feeding" was adopted in 1999 by the country's parliament. As a result, Georgia has witnessed a sharp increase in breastfeeding percentages, the designation of baby-friendly status at 14 maternity houses, and a decrease in the advertisement of artificial-feeding products.     

Ten steps to 4C/ID: training differentiation skills in a professional development program for teachers

Instructional Science - This paper describes how an interdisciplinary design team used the Four-Component Instructional Design (4C/ID) model and its accompanying Ten Steps design approach to...     

Step 8: encourages all mothers, families to touch, hold, breastfeed, care for their babies: the coalition for improving maternity services:

Step 8 of the Ten Steps to Mother-Friendly Care encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions. The rationales for compliance with the step and systematic review are presented.     

Step 5: has clearly defined policies, procedures for collaboration, consultation, links to community resources: the coalition for improving maternity services:

Step 5 of the Ten Steps of Mother-Friendly Care ensures that the hospital, birth center, or home birth service has clearly defined policies and procedures for collaborating and consulting with other maternity services and for linking the mother and baby to appropriate community services during both the prenatal and the postpartum periods. The rationales and evidence in support of this step are presented.     

Step 3: provides culturally competent care: the coalition for improving maternity services:

Step 3 of the Ten Steps of Mother-Friendly Care insures that women receive care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion. The rationale for this step and the evidence in support of its value are presented.     

Step 1: offers all birthing mothers unrestricted access to birth companions, labor support, professional midwifery care: the coalition for improving maternity services:

The first step of the Ten Steps of Mother-Friendly Care insures that women have access to a wide variety of support in labor and during the pregnancy and postpartum periods: unrestricted access to birth companions of their choice, including family and friends; unrestricted access to continuous emotional and physical support from a skilled woman such as a doula; and access to midwifery care. The rationales for the importance of each factor and the evidence to support those rationales are presented.     

Step 7: educates staff in nondrug methods of pain relief and does not promote use of analgesic, anesthetic drugs: the coalition for improving maternity services:

Step 7 of the Ten Steps of Mother-Friendly Care insures that staff are knowledgeable about nondrug methods of pain relief and that analgesic or anesthetic drugs are not promoted unless required to correct a complication. The rationales for compliance and systematic reviews are presented on massage, hypnosis, hydrotherapy, and the use of opioids, regional analgesia, and anesthesia.     

Step 6: does not routinely employ practices, procedures unsupported by scientific evidence: the coalition for improving maternity services:

Step 6 of the Ten Steps of Mother-Friendly Care addresses two issues: 1) the routine use of interventions (shaving, enemas, intravenous drips, withholding food and fluids, early rupture of membranes, and continuous electronic fetal monitoring; and 2) the optimal rates of induction, episiotomy, cesareans, and vaginal births after cesarean. Rationales for compliance and systematic reviews are presented.     

Singing Along the Way to Becoming Baby-Friendly

In this column, two assistant nurse managers describe an innovative and fun strategy they developed and implemented at NYU Langone Medical Center in New York to assist the nursing staff in preparing for their Baby-Friendly auditors’ visit.     

Analysis and Application of the Concept of Modesty to Breastfeeding

Modesty may be a significant variable impacting breast- feeding outcomes in western cultures, yet this term has received minimal attention in the breastfeeding literature. An analysis of the concept of modesty was conducted to gain greater understanding of the potential impact of modesty on breastfeeding outcomes. Various uses of the term modesty and particularly modesty in the context of breastfeeding are discussed in this paper. The defining attributes of breastfeeding modesty are identified and examples are provided. Implications for research and clinical practice are suggested.     

Factors related to breastfeeding discontinuation between hospital discharge and 2 weeks postpartum

Although breastfeeding is known to be beneficial to both mother and infant, many women encounter barriers to breastfeeding, even after successful breastfeeding initiation, which may put them at greater risk for early cessation of breastfeeding. The objectives of this study were to conduct a secondary analysis of data from a longitudinal study of postpartum depression to (a) examine factors related to very early discontinuation of breastfeeding (at 2 weeks postpartum) following hospital discharge and (b) identify women's reasons for very early cessation of breastfeeding. The results of this study support findings from previous research. Having a perceived support system, whether it is personal or professional, may have an effect on both the initiation and duration of breastfeeding. Educating expectant and new mothers, especially women who encounter multiple barriers and are at risk for very early cessation of breastfeeding, of the benefits of breastfeeding and supporting them in developing efficient techniques and problem-solving skills can help increase the duration of breastfeeding.     

Predicting breastfeeding duration related to maternal attitudes in a taiwanese sample

The purpose of this study was to examine maternal attitudes and sociodemographic variables associated with Taiwanese mothers' continuation of breastfeeding at 6 weeks postpartum. A sample of 140 in-hospital breastfeeding mothers was recruited in Taiwan. Participants completed the Iowa Infant Feeding Attitude Scale (IIFAS) in the hospital prior to discharge. Postdischarge participants were contacted by telephone at 3 and 6 weeks postpartum to obtain information regarding their feeding method and duration. Findings revealed that in-hospital maternal breastfeeding attitudes are predictive of breastfeeding duration. Insufficient milk supply was the reason most often given for discontinuing breastfeeding. Women's husband/partner was found to be the main source of breastfeeding support. We recommend health-care professionals add the IIFAS to their assessment to identify mothers at high risk for discontinuing breastfeeding and to develop and better evaluate breastfeeding promotion programs.