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.     

Modified breastfeeding attrition prediction tool: prenatal and postpartum tests

In earlier studies, the Breastfeeding Attrition Prediction Tool (BAPT) demonstrated predictive validity in the postpartum period. The purpose of this study was to compare the effectiveness of a modified version of the BAPT when given in the last trimester (BAPT1) and following delivery (BAPT2) in predicting breastfeeding attrition among 117 women who planned to breastfeed for at least 8 weeks. Subjects completed the BAPT during a prenatal breastfeeding class and again at delivery, and they received a phone call at 8 weeks to determine breastfeeding status. In this study, neither of the two administrations of the BAPT was predictive of breastfeeding status at 8 weeks. Findings here may differ because subjects in the current study were all committed enough to attend breastfeeding class and, thus, varied less on commitment than women in earlier studies. Significant associations were found with level of education and having a close relative who breastfed. To assist the perinatal educator in identifying women most at risk for early cessation of breastfeeding, the use of three questions regarding level of education, family support, and breastfeeding preparation is suggested.     

Current studies on two separate topics: breastfeeding postpartum length of hospital stay

IN THIS COLUMN, THE AUTHOR EXAMINES RECENT RESEARCH ON TWO SEPARATE TOPICS: 1) breastfeeding; 2) postpartum length of hospital stay. Recent studies suggest long-term effects of breastfeeding that benefit both mother and infant. Benefits include a reduced risk of breast cancer in breastfeeding mothers and a reduced level of total and LDH cholesterol in adults who were breastfed as infants. Infants of mothers with maternal asthma had lower rates of asthma if the mother breastfed. In a study of women in the United States who planned to breastfeed, those mothers who breastfed exclusively and planned to breastfeed more than three months were more likely to achieve their goals than mothers who planned to combine breast and human-milk substitute feeds and to breastfeed less than three months.In a Canadian study, shortened postpartum stays led to increased re-admission to hospital for mothers with cesarean births. In contrast, in a Massachusetts study, shortened postpartum stays did not lead to an increase in infant visits for urgent care. However, the Massachusetts study did not reflect a decrease in maternity-related costs associated with shortened length of postpartum stay.     

Professionally mediated peer support and early breastfeeding success

Social support interventions that incorporate professionally mediated peer support (PMPS) for improved breastfeeding outcomes were compared with no special breastfeeding support. Fifty-five breastfeeding mothers participated. The breastfeeding outcomes of duration, completeness, satisfaction, and exclusive breastfeeding were compared at 6 weeks postpartum among an experimental group that received PMPS, and among younger community (YC) and older community (OC) groups that received no special breastfeeding support. The PMPS group exclusively breastfed for a significantly longer duration than the YC group. At 6 weeks, mothers in both community groups who had weaned were significantly less satisfied with their breastfeeding experiences than the mothers who were still nursing their babies. Professionally mediated peer support can improve the early breastfeeding outcomes of duration of exclusive breastfeeding and satisfaction with breastfeeding.     

Does the type of maltreatment matter? Assessing the individual and combined effects of multiple forms of childhood maltreatment on exclusive breastfeeding behavior

BackgroundChildhood maltreatment (CM) has been associated with a range of adult health outcomes; however, extant research has focused more on exposure to a single form of abuse rather than multiple forms. Moreover, very few studies have specifically investigated the impact of CM on exclusive breastfeeding (EBF) outcomes.ObjectivesThis study aims to examine: (1) the individual and combined effects of multiple forms of CM on EBF outcomes; and (2) whether postpartum depression and maternal stress act to mediate or moderate the association between CM and EBF.MethodCross-sectional survey data were collected between October 2015 and January 2016 from 426 women of Bangladesh who were six months postpartum.ResultsBased on the adjusted multivariate logistic regression model, women who experienced childhood sexual abuse (CSA) were significantly less likely to exclusively breastfeed babies than their non-abused counterparts (AOR: 0.38, 95% CI [0.15, 0.92]). When a composite measure was created to examine the additive effects of adverse childhood experiences, a dose-response association was observed between the reported number of different types of CM and early termination of EBF. Though experiencing postpartum depression and maternal stress do not mediate the effect of CSA on EBF, they do moderate them such that the odds of early termination of EBF are notably higher among women who experienced CSA in combination with postpartum depression or high levels of stress.ConclusionsFindings from this study offer some insight into the intergenerational effects associated with CM experiences, and underpin the need for effective policies and programs to prevent or reduce its occurrence and improve the EBF outcomes.     

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.     

Postpartum depression, marital dysfunction, and infant outcome: a longitudinal study

This longitudinal study explores the relationship of postpartum depression (PPD) and marital dysfunction on infant outcomes from birth to 2 1/2 years of age among middle-class, postpartum women. Participants were recruited during the prenatal period. Twelve mothers completed the study throughout a 2 1/2-year period. Questionnaires, semistructured interviews, and observations were used to collect data. Content analysis of the interviews (Morse & Field, 1995) was conducted and thematic patterns were identified. Clinical PPD and marital dysfunction (defined as little or no support or closeness, or verbal, emotional or physical abuse) characterized nearly one in three mothers. Four themes describing the women's postpartum progression were identified: stress, isolation, resentment, and eventual adjustment by creating a new normal. No major developmental delays or behavioral problems were found among the infants. Eight of the 12 mothers who were initially identified as breastfeeding nursed their infants for 6-18 months. Regardless of financial and educational advantages, mothers in the study experienced depression and marital dysfunction. These findings support other studies that confirm the lack of association of PPD with social class or marital status. Childbirth educators and other health care professionals are encouraged to continue providing expectant families with anticipatory education and community resources in order to increase awareness of mental health and marital risks during the postpartum transition.     

Midwife Learns Lessons as a Hospital Patient

After her first-time experience as a patient in a hospital, a midwife and childbirth educator reflects on the vulnerability and dependence of women who undergo operative birth. Continuous support for these women during the early postpartum period is imperative. Childbirth educators are encouraged to advocate for these women's needs and to teach them how to advocate for themselves.     

Care practice #6: no separation of mother and baby, with unlimited opportunities for breastfeeding

This updated edition of Care Practice Paper #6 presents the evidence for the benefits of keeping mothers and babies together after birth. The normal physiology of the postpartum and early newborn periods is explained. The author reviews the influence of early and frequent skin-to-skin contact and rooming-in on breastfeeding and early attachment. Women are encouraged to choose a birth setting that does not routinely separate mothers and babies and to plan for early and frequent skin-to-skin contact and rooming-in.     

Research Summaries for Normal Birth

In this column, the authors summarize four research studies relevant to normal birth. Topics of the studies summarized include the harms of screening for macrosomia late in pregnancy, the risk factors for and impact of postpartum pain in childbearing women, the effects of a breastfeeding approach called “biological nurturing” on reflexive behavior in newborns, and the effects of prenatal yoga on labor and birth outcomes.     

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.     

Maternal-newborn nursing: thirteen challenges that influence excellence in practice

The purpose of this paper is to review the research and discuss 13 challenges that currently influence excellence in maternal-newborn nursing practice. Nurses working in the maternal-newborn arena are encouraged to evaluate their own practices in relation to the identified areas. The 13 identified challenges are the following: integration and expansion of midwifery and family-centered models of care, reduction in the use of unnecessary or questionable-benefit technology, patient and family teaching, the questionable need for a normal newborn nursery, integration of research into practice, further development of genetic technology and counseling, computer technology as an adjunct to prenatal care and birth, the need for comprehensive breastfeeding education and support, prenatal care on a continuum beginning as women's health promotion, health promotion beyond the postpartum period, culturally competent care, health insurance coverage for all women and children, and an undereducated work environment.     

Japanese Translation and Cultural Adaptation of the Listening to Mothers II Questionnaire

The questionnaire used for the U.S. Listening to Mothers II survey was translated and culturally adapted to measure Japanese women's experience during the period of pregnancy planning through early postpartum. Methods included expert panels and two phases of cognitive interviews with 20 postpartum Japanese adult women. The number of problems with the translated questionnaire effectively decreased in the iterative process. Most problems were found in the question-interpretation stage of cognitive processing, such as wording/tone. Culture-specific concepts and unclear items were adapted to prevent erroneous interpretations in future studies. The future use of this questionnaire to generate data sets will be useful for professionals interested in developing evidence-based practices. The knowledge from this study can be helpful in improving health-care services and education for women with diverse languages and cultural backgrounds.     

Breastfeeding Attitudes of WIC Staff: A Descriptive Study

A sample of staff members from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC program) were interviewed about breastfeeding and their perceptions of WIC recipients' views on breastfeeding. WIC staff members universally supported breastfeeding and expressed desires for more linkages between WIC agencies and perinatal education specialists in childbirth education classes, as well as with mothers during their postpartum hospital stay. The WIC staff members in this study reported on a variety of beliefs about breastfeeding held by their WIC clients, including cultural beliefs, the importance of family support, and experiences of pain during breastfeeding.     

Postpartum Depression: How Childbirth Educators Can Help Break the Silence

The voices of women suffering from postpartum depression are often silent. Women are reluctant to reveal to others that they are unhappy after the birth of their babies. Much has been written on possible causes, risk factors, and treatments for postpartum depression, but little has been done to investigate why women take so long to seek help. Early detection and treatment are key to a full recovery. Childbirth educators are in the position to offer anticipatory guidance on possible complications of the postpartum period, including postpartum depression. This article explores why women with postpartum depression choose to suffer in silence and suggests how childbirth educators can help new mothers find their voices.     

Maternal history of child maltreatment and maternal depression risk in the perinatal period: A longitudinal study

Existing research is limited, with only a few studies considering each single type and multiple types of child maltreatment (CM) as well as multiple assessments of maternal depression throughout the perinatal period. The purpose of the study was to assess each type and accumulative types of CM in relation to the risk of maternal depression throughout the perinatal period. In total, 276 pregnant women were recruited from the prenatal clinic at a general hospital in China. Maternal CM history and depression risk were assessed at late pregnancy, postpartum week 1, and postpartum week 4 using the Childhood Trauma Questionnaire (CTQ) and Edinburgh Postnatal Depression Scale (EPDS). The GEE showed that physical and emotional neglect and multiple types of CM were associated with higher overall depression risk across the perinatal period. The multinomial regression models showed physical neglect and multiple types of CM predicted higher risk of both antepartum and postpartum depression. Emotional and sexual abuse and emotional neglect predicted antepartum depression risk, while none of the three types of CM predicted postpartum depression risk. Physical abuse did not predict antepartum and postpartum depression risk. The findings suggest that maternal history of child physical and emotional neglect play significant roles in perinatal depression risk with physical neglect as the most important predictor. Routine screening for maternal CM history and depression risk in prenatal clinics is needed to aid in the early detection and treatment of depression.     

Major Survey Findings of Listening to MothersSM III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women’s Childbearing Experiences

To understand the experiences and views of childbearing women in the United States and trends over time, Childbirth Connection carried out the third national Listening to Mothers survey among 2,400 women who gave birth in U.S. hospitals to a single baby from mid-2011 to mid-2012 and could participate in English. Harris Interactive conducted the survey using a validated methodology that includes data weighting to ensure that results closely reflect the target population. Results of the initial survey describe experiences from before pregnancy through the early postpartum period, and were reported in Listening to Mothers III: Pregnancy and Birth. A follow-up survey directed to the same participants explored postpartum experiences, attitudes about maternity care, and some additional pregnancy and birth items.     

Prenatal and early postnatal depression and child maltreatment among Japanese fathers

We investigated the association of paternal depression in the prenatal and early postnatal period with child maltreatment tendency at two months postpartum among Japanese fathers. This population-based longitudinal study recruited Japanese perinatal women and their partners living in Nishio City, Aichi, Japan. Of the 270 fathers who participated, 196 were included in the analysis. All data were collected via self-administrated questionnaires at four time points: 20 weeks’ gestation and in the first few days, one month, and two months postpartum. Paternal depression was assessed using the Edinburgh Postnatal Depression Scale. Three definitions of paternal depression were coded based on participants’ scores on this measure: prenatal, prior, and current. Child maltreatment tendency was evaluated using the Child Maltreatment Scale at two months postpartum. The associations of the three definitions of paternal depression and child maltreatment tendency were separately analyzed using logistic regression analysis. The prevalence of prenatal, prior, and current paternal depression was 9.7%, 10.2%, and 8.8%, respectively. According to the multivariate analysis, current paternal depression was significantly associated with child maltreatment tendency at two months postpartum (adjusted odds ratio: 7.77, 95% CI: 1.83–33.02). The other two types of depression, however, were not related to child maltreatment tendency. Thus, current paternal depression increased the risk of child maltreatment tendency in the postnatal period, suggesting that early detection and treatment of paternal depression might be useful for the prevention of child maltreatment.     

Childhood maltreatment,postnatal distress and the protective role of social support

The postpartum period is a vulnerable period for women with a history of childhood maltreatment. This study investigated the association between childhood maltreatment and postnatal distress three months postpartum and examined the role of social support provided by different sources (intimate partner, parents, parents-in-law, and friends). Analyses are based on N = 66 women, who were screened for maltreatment experiences shortly after parturition with the Childhood Trauma Questionnaire. Their levels of postnatal distress (symptoms of depression, anxiety, and stress; assessed with the Hospital Anxiety and Depression Scale and the 4-Item version of the Perceived Stress Scale) and postpartum social support (measured with the Postpartum Social Support Questionnaire) were assessed three months postpartum. Adjusting for educational level and the experience of a recent stressful event, childhood maltreatment was directly associated with higher levels of postnatal distress. Social support provided by friends moderated this association in a heteroscedastic regression analysis. No moderating effect was observed for support provided by the own parents, the intimate partner, or parents-in-law. The association between childhood maltreatment and postnatal distress was not mediated by social support. Additional analyses revealed no main, moderating, or mediating effects of satisfaction with support. Results suggest that support provided by friends may promote resilience during the postpartum period in women with a history of childhood maltreatment. Efforts to better understand the role of postpartum support and mechanisms that may enhance a mother’s ability to develop and maintain supportive friendships may be promising for guiding preventive interventions.     

影响早期母乳喂养的问题及护理

目的探讨早期母乳喂养存在的问题及护理措施。方法分析总结1882例新生儿母乳喂养情况。结果通过早期对产妇进行母乳喂养的适时帮助,大大提高了早期母乳喂养的成功率。结论开展系统宣传教育,采取综合护理措施是提高早期母乳喂养成功率的保证。