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Round Table Discussion: Predictors of Breastfeeding (Part Two)

Today, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.  Each
author’s title and JHL research article can be found on the first article of this series: Round Table Discussion: Predictors of Breastfeeding Duration (Part One)

As breastfeeding advocates, what recommendations can you make for us to help increase breastfeeding duration in our communities?

Lucía Colodro Conde:  Influences from factors related to breastfeeding duration should not be considered immutable. Researchers and practitioners should consider the social environment in which influential factors take place, as this may modulate its impact. Family structure, social support, norms about natural or artificial infant feeding,
working conditions, health promotion interventions, or hospital practices, among others, could moderate this interaction. Interventions should be adapted to the mother’s conditions as a whole, taking into account their personal and social characteristics and their social context. Interventions should start before childbirth and support and guidance should be readily available to those women who aim to breastfeed, taking into account their individuality and the characteristics of the communities.

Pippa Craig:

  • Culturally appropriate and practical information at earlier stage of pregnancy.
  • Engage senior Aboriginal women to support younger women during pregnancy.
  • The importance of involving peer support by members of the Aboriginal community, as well as professional support for this cultural group.
  • Engage younger community mothers who have successfully breastfed to act as role models.

Pat Benton and Beth H. Olson: Even mothers who are intent on breastfeeding and
get support in the hospital, from family, or from programs like the BFI, indicate they do not find the environment outside their home to be supportive of breastfeeding-they even find it to be disapproving. Local breastfeeding coalitions where community partners (i.e., physicians, nurses, Lactation Consultants, business owners, etc.) come together to support breastfeeding have been successful in changing the community atmosphere regarding breastfeeding. Also, mothers find support groups/moms clubs, where they can go and share their experiences and receive support that breastfeeding is the natural way to feed
their babies, a great support system.

After completing your research, what additional factors would you like to see studied as predictors of breastfeeding duration?

Lucía Colodro Conde:  At the moment, we have two lines of research about some factors that, according to preliminary studies, are related to breastfeeding duration and can help to understand and predict it. First, we want to focus on which part of this health behavior is due to differences in genetic configuration and differences in environmental factors among individuals. And second, we aim to analyze the relationships between
psychosocial and personality factors, and the establishment and duration of breastfeeding. We highly support the need of a multidisciplinary approach to this complex behavior.

Pippa Craig:  Further explore psychological factors predicting breastfeeding duration. Introduce and evaluate more culturally acceptable pre-, peri and post-natal services for Aboriginal women.

Pat Benton and Beth H. Olson: We would like to see more work done with populations with low breastfeeding rates, to better understand their particular barriers
such that we might develop targeted support programs. We would also like to see more cost-effectiveness work done on breastfeeding and breastfeeding support that might help us impact public policy and private organizations so they improve breastfeeding support. Research suggests factors that impact breastfeeding in the first day(s) greatly diminish breastfeeding duration; we need to better understand how to provide support in the hospital and in the first days a mother is home with her new baby-including home visiting/follow up care for new mothers.

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Round Table Discussion: Predictors of Breastfeeding (Part One)

Over the past few years, the Journal of Human Lactation has highlighted several research articles that measured factors that directly impact breastfeeding duration.  As health care professionals and lactation consultants, the outcomes of these research projects should inform the way we practice as well as help us to target areas where we can support mothers to increase breastfeeding duration in our communities and countries.

Four authors from around the world have generously offered to share their research and offer recommendations to us based on their findings:

Lucía Colodro Conde, BA, MSc.
Psychologist, Master on Clinical and Health Psychology. Seneca Foundation Research Scholarship. Department of Human Anatomy & Psychobiology. (University of Murcia) Spain.
August 2011: Relationship Between Level of Education and Breastfeeding Duration Depends on Social Context: Breastfeeding Trends Over a 40-Year Period in Spain

Dr. Pippa Craig, Ph.D
Academic Coordinator, Inter-Professional Learning
TheHealth ‘Hubs and Spokes’ Project
ANU COLLEGE OF MEDICINE, BIOLOGY AND ENVIRONMENT
Australian National University
August, 2011: Initiation and Duration of Breastfeeding in an Aboriginal Community in South Western Sydney

Pat Benton, MS, RD, CLE
Program Manager
Michigan Breastfeeding Initiative
Michigan State University Extension

Beth H. Olson, Ph.D.
Associate Professor; Extension Specialist
Associate Department Chair
Director of Graduate Studies
Food Science; Human Nutrition
Michigan State University
February, 2009: Characteristics Associated With Longer Breastfeeding Duration: An Analysis of a Peer Counseling Support Program

What were the largest factors predicting breastfeeding duration in your study?

Lucía Colodro Conde:  In our study we focused specifically on the mother’s level of education, which has been reported to be related to breastfeeding practices. We analyzed the relationship between this variable and the breastfeeding trends in a region of Spain during a 40 year period, along the second half of the 20th century.  We found that the direction and/or magnitude of the association were not constant across time and level of education, suggesting that other factors may moderate this relationship depending of the social context (i.e., family structure, social support, or working conditions).

Pippa Craig: This study has confirmed that more educated mothers of Australian Aboriginal infants in an outer urban environment, and those intending to breastfeed, were more likely to breastfeed. Intention to breastfeed was the strongest predictor.

Pat Benton and Beth H. Olson: Among low-income mothers we found formula
introduction by day one predicted shorter breastfeeding duration. Many mothers in our studies that identify themselves as breastfeeders still supplement with formula or cereal earlier than recommended. Lack of social support leads to shorter breastfeeding duration; new mothers have no role models for breastfeeding, and rely heavily on support from family who discourage them from breastfeeding. We also found that many working women don’t consider combining breastfeeding and employment-they see these two roles as mutually exclusive. They don’t initiate breastfeeding or wean prior to going back to school or work.

What were the most significant findings in your study?

Lucía Colodro Conde:  Our main finding was that the association between maternal education and breastfeeding is not consistent over time.  Today, a higher level of studies
appears to predict a longer duration of breastfeeding; this has not always been the case.  Among women with fewer school years, breastfeeding duration reduced very early in the period studied and remained at low levels for the rest of the duration. Meanwhile, among women with secondary education or higher, the duration of breastfeeding also reduced
markedly until the 1970s, but then it began to increase steadily until the late 1990s. These trends could change again following societal evolution.

Pippa Craig: Low initiation rates and a rapid decrease in breastfeeding rates. This suggests either a lack of commitment or lack of support to assist new mothers with any
early difficulties with breastfeeding. There was a tendency for mothers to receive antenatal care late in their pregnancy, and there was a lack of adequate and culturally appropriate antenatal/postnatal support services in the area.

Pat Benton and Beth H. Olson: A peer counselor (a breastfeeding mother from the community, trained to provide support and referrals and making home visits) from The Breastfeeding Initiative program of MSU- Extension and WIC, significantly increased breastfeeding rates among low income mothers. This duration is longer even compared to mothers referred to the program but not enrolled (due to overcapacity), showing even among women motivated to find support-those with peer counselors breastfed longer. We found that low income mothers may receive infant feeding advice from several sources (Extension, physicians, nurses, home visiting programs, WIC) and find it conflicting. This contributes to factors, such as early introduction of formula, which may impact breastfeeding duration.

In Part Two, our authors will discuss recommendations for health care professionals and lactation consultants to help increase breastfeeding duration in our communities, as well as potential factors to study in future research projects.

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Round Table Discussion: Baby Friendly Health Initiative

Protecting, Promoting and Supporting Breastfeeding

What is the Baby Friendly Health Initiative (BFHI)?

Baby Friendly Health Initiative is a World Health Organization (WHO) and UNICEF a worldwide program launched in 1991 following the Innocenti Declaration of 1990 that aims at creating a health care environment that supports mothers and babies to have the best start in life. This may have evolved in your country to suit your specific needs and some examples are; the BFI (Baby Friendly Initiative), BFHI (Baby Friendly Health Initiative) or Baby and Mother Friendly Hospital Initiative. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breastmilk Substitutes.

Creating a health care environment where Breastfeeding is the norm, Practices known to promote the health and well-being of all babies and their mothers are followed.

The Ten Steps to Successful Breastfeeding is the minimum global standard by which hospital facilities are assessed and accredited. A ‘Baby Friendly’ facility is one where a mothers’ informed choice of infant feeding is supported, respected and encouraged. Community Health has seven steps.

Baby Friendly Accreditation is a quality improvement measure which demonstrates that a facility offers the highest standard of care to all mothers and babies. Attaining accreditation reflects the commitment of the facilities staff.

To achieve this standard, midwives and other carers obtain an increased knowledge of infant feeding, greater skills and commitment to facilitate breastfeeding. This engenders an environment that encourages best practice, improving the health of new generations.(bfhi.org.au). See additional links below for more information.

Participants:

Angela Smith, RN CM IBCLC FILCA  Nurse Unit Manager

Royal Prince Alfred Hospital Sydney Australia BFHI Accredited 2011

 

Cathy Holland RN, BS, IBCLC, FACCE, LCCE

Over my 46 years as a registered nurse, Women’s Health, focusing on lactation and birth using both traditional and energy medicine to facilitate success is my passion.

 

Trish MacEnroe Executive Director

Baby-Friendly USA, Inc.

tmacenroe@babyfriendlyusa.org

Cindy Turner-Maffei, MA, IBCLC National Coordinator

Baby-Friendly USA, Inc.

 
1. Why should a hospital work toward BFHI certification?

Angela Smith (AS): All hospitals want to provide the best possible care they can and we know that the BFHI accreditation is the Gold Standard in not only Breastfeeding Care but in excellent Postnatal care generally.

Cathy Holland (CH): BFHI accreditation indicates the facility is making efforts to show the community they value infant nutrition, over free products from companies who are more interested in $$$$$$ than mother-baby health.

Trisha & Cindy (TC): The Baby-Friendly Designation is the globally recognized symbol of world-class maternity care practices that lead to optimal infant feeding outcomes.  In this process birth facilities

  • deliver patient-centered care
  • improve health outcomes and patient satisfaction
  • increase community recognition of excellence
  • enhance a professional environment of competence, including leadership and team skills
  • demonstrate a commitment to quality improvement
  • meet corporate compliance requirements

In the US this may also

  • improve m-PINC scores
  • meet Joint Commission maternity care standards for exclusive breast milk feeding
  • lead the way to achieving Healthy People 2020 goals for breastfeeding

2. Why should expectant parents choose a BFHI facility?

AS: Expectant parents like the rest of the population these days will search the internet looking for the hospital that provides the best service. By being BFHI accredited the new parents are reassured that the hospital they have chosen has gone “the extra mile” and will provide them with First class care.

CH: Securing the best possible care should be a concern. Often the choice of facility is “where they have insurance coverage.” A BFHI facility has made an effort, greater than that which is required of them. Having this designation could nudge the insurance payers to notice the BFHI facility. Health and $$$$$ savings are the expected outcomes.

TC: Baby-Friendly birth facilities have taken special steps to create the best possible environment for bonding with and feeding your baby.  The Initiative celebrates hospitals and birth centers that have put in place policies and practices to enable parents to make informed choices about how they feed and care for their babies.   Birthing facilities voluntarily seek out this designation as a demonstration of their commitment to new families.

3.  What does BFHI mean for us (me/my baby/my family)?

AS: The idea of BFHI means quality for each group. For staff it means they know they are working in a hospital that is not frightened of accreditation but is proud of its achievements.  For new parents and families it gives them peace of mind that the facility they have chosen is committed to breastfeeding and giving quality care.

CH: The BFHI means the health facility in my neighborhood is prepared to offer the best possible start for families. Creating health in every way is a great philosophy for a facility.

TC: In a Baby-Friendly birth facility you will have the opportunity to hold your baby skin to skin immediately following birth, you will be able to have your baby stay with you in your room during your entire hospital stay and you will have the confidence in knowing that you are being cared for by highly trained staff who can help you learn to respond to your baby’s specific needs. Staff will also help you to identify supportive resources in your community to help you with infant feeding after you go home.

4. What is some recent research or statistics relating to BFHI?

AS: ‘Baby Friendly’ accredited hospitals in Australia is 77 which is 23% of all Australian hospitals providing maternity services (based on approximate number of facilities being 330).

TC: US STATISTICS

114 designated hospitals http://babyfriendlyusa.org/eng/03.html

4.5% of births take place in Baby-Friendly Hospitals http://www.cdc.gov/breastfeeding/pdf/2011BreastfeedingReportCard.pdf

RESEARCH

The Ten Steps to Successful Breastfeeding have been demonstrated to increase both initiation and duration of breastfeeding

DiGirolamo AM, LM.Grummer-Strawn and SB Fein. 2008.  Effect of Maternity-Care Practices on Breastfeeding Pediatrics122;S43-S49

Merten, S, et al. 2005. Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics 116; e702-e708.

Philipp BL et al. 2001. Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting. Pediatrics 108(3):677-681.

DiGirolamo AM, LM Grummer-Strawn, S Fein. 2001. Maternity care practices: implications for breastfeeding. Birth 28:94-100.

Kramer MS et al. 2001. Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA 285:413

For more information check out these sites:

http://www.bfhi.org.au/

http://www.unicef.org.uk/babyfriendly/

http://www.babyfriendlyusa.org/eng/index.html

http://www.waba.org.my/

http://www.babyfriendly.org.nz

http://www.who.int

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