Tag Archives | breastfeeding duration

Increasing breastfeeding duration: One Sling at a Time!

Written by Jennie Bever Babendure, PhD, IBCLC

Author Jennie Bever Babendure with her little one

By now, most of us in the lactation field have heard of Kangaroo Mother Care (KMC). Maybe you’ve even been lucky enough to hear Nils Bergman speak passionately about the work he’s done using KMC, and its benefits for premature infant thermal regulation and brain development. Most importantly for those of us in the lactation world, the skin-to skin contact (SSC) used in KMC is associated with increased breastfeeding duration. Despite all the attention SSC and KMC have received, no one has yet looked at the impact on breastfeeding of mother/infant body contact beyond the first hours after birth in term infants.

A recent article in Acta Paediatrica by Continisio, Continisio, Filosa and Tagliamonte, set out to remedy this by designing an intervention to increase mother/infant body contact in the first month of life. 100 Italian mothers were given information on breastfeeding as well as a cloth baby carrier. They were shown how to put their (clothed) infants into the carrier and asked to wear the baby in the carrier as often as possible, and for at least 1 hour per day during the baby’s first month. Control mothers were given information on breastfeeding only.

What they found surprised even me, a sling-wearing, card-carrying member of the babywearing fan club.

Photo by hugabub via Flickr Creative Commons

Mothers in the intervention group were 1.8 times more likely to still be breastfeeding at 2 months and 2.9 times more likely to still be breastfeeding at 5 months and breastfed their babies significantly more often (times per day/ night) at 1 and 2 months. Mothers in the intervention were also more likely to be exclusively breastfeeding at 2 and 5 months. In addition, the majority of the mothers who used the baby carrier felt it was useful for breastfeeding as well as bonding, understanding of baby needs, and getting things done.

Wow!

For me, these results are staggering. The intervention is simple, requires minimal skill to administer, and mothers and babies are not only getting the health advantages of longer and more exclusive breastfeeding, they’re also getting more bonding time and getting things done! It is for this last reason, I would imagine, that women the world over have chosen to carry their babies in cloth carriers for thousands of years. They, like many mothers who use cloth carriers these days, likely could have told us that babywearing makes breastfeeding easier. Thanks to this study, we now know that it also helps mothers breastfeed longer and more exclusively.

This study provides solid evidence that increased mother/baby contact through the use of a baby carrier can increase breastfeeding duration and exclusivity. Although this study was done with only one type of carrier, I would guess that most carriers that allow mothers to wear their new babies close to their chests (as in KMC) would be of similar benefit.

One of my favorite resources for all things babywearing is www.thebabywearer.com. They have reviews, forums, and information on buying, making, and using baby carriers of all kinds. Be sure to check out the resources on their homepage on safe positioning. Like any type of baby gear, baby carriers must be used properly, and it’s important to check to make sure that any baby carrier you use has not been recalled.

I’m not sure I would have made it through the first few months without a baby carrier. In fact as I finish this post, my son is snuggled against my chest in a carrier while we sway back and forth to Neil Diamond.

Have you or the mothers you work with used a baby carrier? Have you found it to make breastfeeding easier?

Pisacane A, Continisio P, Continisio GI, Filosa C, Tagliamonte V. Use of baby carriers to increase breastfeeding duration among term-infants: the effects of an educational intervention in Italy. Acta Paediatrica 2012:epub ahead of print.

Jennie Bever Babendure, PhD, IBCLC: I am mom to 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates. For more research news and commentary, check out my blog at www.breastfeedingscience.com.

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What Do Undergraduates Think about Breastfeeding?

Written by Robin Kaplan, M.Ed., IBCLC

Photo by j.o.h.n. walker via Flickr

It is well known that in the United States, breastfeeding rates are somewhat discouraging. With only 35% of babies exclusively breastfeeding at 3 months and 44.3% receiving any breast milk at all at 6 months, as a nation we are not meeting the standards set forth by the American Academy of Pediatrics nor the World Health Organization. As we continue to look at ways in which we can increase our breastfeeding rates, one suggestion has been to examine the breastfeeding education taught to nonpregnant youth.

An article in the upcoming issue of the Journal of Human Lactation explores this issue. Kavanaugh, et al. surveyed 248 nonpregnant undergraduate youth at a large research university in Tennessee to determine their breastfeeding knowledge, attitudes, prior exposure, and breastfeeding intent (For subscribers to The Journal of Human Lactation, you can read the full text of the paper here).

The most significant findings from the study were:

  • Over 90% of the participants agreed that breastfeeding should be started soon after birth and that breast milk and formula were not the same. However, only about 50% of the participants knew that breastfeeding can reduce a mother’s risk of cancer and that formula-fed infants are ill more often than breastfed babies.
  • While a majority of the participants believed that breastfeeding was cheaper and healthier than formula, an astounding number felt that breastfeeding in public was embarrassing and unacceptable (71% female, 47.7% male) as well as inconvenient and painful (47.8 female, 33.8% male).
  • Those who had been breastfed as infants scored significantly higher on breastfeeding knowledge and positive attitude towards breastfeeding than those who were unsure or had not been breastfed.
  • The majority of the participants (80%) intended to breastfeed/support a partner to breastfeed in the future.

So where do we go from here? How do we change the attitudes of children, adolescents, and young nonpregnant adults about breastfeeding?

  • This research study is limited in its generalization due to the sample of the participants, therefore we need more wide spread, longitudinal studies of adolescents and young adults’ breastfeeding knowledge and attitudes.
  • We need better support and legislation to protect breastfeeding in public. If breastfeeding in public becomes the norm, as it is in MANY other countries, it should decrease the perception that it is embarrassing, unacceptable, and inconvenient. It’s time we start seeing more of this:

    Photo via blondebutbright.blogspot.com

    and less of this:

    Photo by Kate Gulbranson (@hygeiakate)

  • Additional curriculum, like the one pioneered in NY State, that promotes breastfeeding as the norm, in human development and nutrition classes for children, adolescents and college students. The bulk of the content could focus on the benefits of breastfeeding (for both mother and baby), the hazards of formula, and the superior nutritional components of breast milk.
  • A recommendation, per the authors (which I personally think is brilliant), it also to educate our youth about appropriate infant development and behavior. The authors concluded that if our youth understood how often an infant/toddler needed to breastfeed and that covering with a blanket was not always feasible (especially with an older infant who wants to see the world around him/her), that they might stop viewing a breastfeeding mother as being immodest when breastfeeding in public. Also, since an infant typically breastfeeds every few hours, it is irrational to expect this mother to stay at home for every feeding.

What recommendations would you add to this list? How does your community make breastfeeding the norm?

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of the International Lactation Consultant Association’s (ILCA) blog, Lactation Matters, and a regular contributor to ILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show, which launches on July 2, 2012, and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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How can we best support mothers to reach their breastfeeding goals?

Written by Jennie Bever Babendure, PhD, IBCLC

Photo via laurabl @ Flickr

Despite the recent media attention on toddler breastfeeding, a majority of women in the US and many other countries struggle to reach even 6 months of breastfeeding. To help mothers reach their breastfeeding goals, researchers have long created and studied support interventions. On May 16th, a review and meta-analysis was released by the Cochrane Collaboration looking at breastfeeding support interventions at the highest tier of evidence, randomized and quasi-randomized controlled trials. The study, “Support for healthy breastfeeding mothers with healthy term babies” focused on the effectiveness of 52 postnatal support interventions from 21 countries between 1979 and 2011 looking at primary outcomes of breastfeeding duration and exclusivity in healthy full term babies born to healthy mothers. 1

While some of their findings came as no surprise, others are very telling for the future of our efforts to increase breastfeeding duration and exclusivity all over the world.

What we might have expected:

1. Taken as a whole, support interventions reduced the number of women who stopped breastfeeding before 6 months and reduced the number of women who were no longer breastfeeding exclusively at 4-6 weeks and at 6 months.

2. Face to face support was more effective than telephone support

What we might not expect:

3. Support interventions were more effective in populations in which breastfeeding initiation was high.

Support is more effective when women are already motivated to breastfeed.

4. Lay support was more or as effective as professional support in reducing breastfeeding
cessation.

As the most common reason mothers cite for stopping breastfeeding is the perception of not enough milk, encouragement and education from a peer counselor, community health worker, or other lay supporter can be exactly what a mother needs to reach her goals.

Most significantly, the study found that:

5. Interventions in which mothers had to ask for support, travel a distance to access
support, and in which only one interaction was provided were NOT effective at increasing
breastfeeding duration and exclusivity.

The review goes on to conclude that “Support that is only offered if women seek help is unlikely to be effective. This indicates that women should be offered predictable, scheduled, ongoing visits.” For most countries, providing this type of proactive support to all mothers would require systematic change. Most of the reviewed studies provided support by home visits or telephone calls to mothers soon after birth and continuing for many weeks postpartum. Home visits by lactation consultants, nurses, midwives, and peer counselors have demonstrated positive results, as has an intervention to incorporate lactation consultations into the regular pediatric office visits. For a more in-depth discussion of the need for proactive support, see my most recent post at www.breastfeedingscience.com.

Based on the above findings it is clear that if we are to create systematic, sustainable impacts on how mothers feed their children, we need to think about how ongoing proactive support for breastfeeding mothers can best tie into our existing culture. Given the recent movement towards sustainability and health, our community has an opportunity to put forth a unified front and effect change to ensure that routine lactation support is as normal as a pediatric check-up.

The 203 page study is freely accessible in its entirety here.

1. Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 2012; 5.

Editor’s Note:  Please take the opportunity to read Jennie’s companion post to this one on her blog. In it, she highlights how formula companies have figured out how to make their product available to mothers in the ways mentioned above and makes suggestions for ways that lactation professionals could change their thinking on such matters.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

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Time Magazine Cover – ILCA’s Response

Written by Lisa Mandell, IBCLC, Secretary ILCA Board of Directors

via Time Magazine

By now, many of you have heard about, seen, and talked about Time Magazine’s recent cover featuring a mother breastfeeding her three-year-old son. The cover photo accompanied a story about Attachment Parenting and Dr. Bill Sears.  There have been numerous blog posts written on the topic already from major media outlets such as USA Today and the Huffington Post, from breastfeeding mothers and from several of our colleagues serving breastfeeding mothers, including the Academy of Breastfeeding Medicine, and Best for Babes.

ILCA would like to remind all of us that breastfeeding beyond infancy is normal, and in many parts of the world, children wean typically between 2 and 5 years of age. As members of ILCA, we do not want to be any part of pitting one mother or her choices in parenting against another mother, as the Time cover encourages. We endeavor to provide and disseminate evidence-based information on breastfeeding, including breastfeeding beyond infancy. We encourage greater support for all mothers and families, from governments, employers, and society. And we welcome the discussion this opportunistic cover has started. Let’s continue that discussion with mothers, clients, friends, acquaintances, employers, health care professionals, even the stranger in front of us in the checkout line. We will help all mothers by continuing to explain the normalcy of breastfeeding, the continued benefits of breastfeeding until the child weans, and the need to support all mothers.

Lisa Mandell, MBA, IBCLC has been working with breastfeeding mothers and babies for over twelve years, first as a volunteer breastfeeding counselor through La Leche League, and then as an International Board Certified Lactation Consultant. Lisa has a private practice seeing mothers and babies in their homes, and has also worked as a lactation consultant in hospitals and a pediatrician’s office, and teaching breastfeeding classes for a birth center. She has been involved in her USLCA chapter as President, CERP Coordinator, and is currently coordinating work on a mentoring consortium to provide a variety of clinical experiences for aspiring lactation consultants. She is pleased to serve as Secretary on the ILCA Board of Directors.
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Do Interruptions Interfere with Early Breastfeeding?

By Jennie Bever Babendure, PhD, IBCLC

In the Jan/Feb 2012 edition of the American Journal of Maternal Child Nursing, Barbara Morrison and Susan Ludington-Ho published a study looking at Interruptions to Breastfeeding Dyads in an LDRP Unit(1).   They observed the doors to the rooms of 30 breastfeeding mother-infant dyads in a community hospital birthing center from 8AM to 8PM on post-delivery day 1, and found that mothers were interrupted an average of 53 times in that 12 hour period.  The average duration of interruptions (18.5+/- 34.5min) was longer than the average duration of time alone (15.4+/-17.3 min), and half of the episodes of time alone lasted 10 minutes or less.

As mothers in the study reported that they spent an average of 25.68 minutes (+/-16.7) at each breastfeeding session, these interruptions were likely to impact early breastfeeding when frequent breast stimulation is critical.  In fact, breastfeeding frequency was moderately negatively correlated with the number of interruptions.  Additionally, the authors found that a mother’s satisfaction with her breastfeeding experiences was significantly correlated with her perception of amount of time alone with her infant, and when mothers felt interruptions interfered with breastfeeding; they found the interruptions more annoying.

Although I was astonished at the number of interruptions this study found in a 12 hour period (consistent with an earlier study in a university hospital(2)), I was not surprised that frequent interruptions impact breastfeeding. Given attitudes in the United States about breastfeeding in public, mothers may feel self-conscious about baring their breasts to visitors, nurses, and other hospital staff members while learning to breastfeed. Ideal amounts of skin-to-skin contact and relaxation may be difficult to accomplish when mothers feel they need to keep one eye on the door and a cover-up at the ready.  Even when this isn’t the case, a mother who finds herself continually interrupted to place her lunch order, talk to visitors, answer the phone, have her vitals checked, and talk to physicians may delay or shorten breastfeeding sessions.

Not surprisingly, the majority of the women in the study only met the minimum recommended number of breastfeeding sessions (4 times in 12 hours), and several mothers fed their babies only 2 or 3 times for less than 15 minutes in that time frame.  As infrequent and inadequate breastfeeding sessions can rapidly progress to infant weight loss and supplementation, this finding is particularly relevant to the cause of increasing breastfeeding duration and exclusivity. Coupled with this, frequent interruptions may prevent mothers from getting the rest they need to recover from childbirth and have the energy for frequent nighttime feedings.

Undoubtedly, many interruptions are necessary and unavoidable; however Morrison and Ludington-Hoe have a number of suggestions to minimize the impact on breastfeeding.  These include:

  • Discuss the importance of alone time, Kangaroo care, frequent breastfeeding and limited visitors during prenatal visits, classes and tours.
  • Cluster care, plan care activities with mothers to enable quiet times, use door signs to signal time alone, and institute “quiet” times when no visitors or staff enter rooms.
  • Minimize rounds and discontinue 24/7 visiting hours.

In our efforts to translate high breastfeeding initiation rates into longer breastfeeding duration, we must continue to remove barriers to establishing a successful breastfeeding relationship.  As we think about how to best accomplish this task, minimizing the frequency of interruptions to mothers and baby may be a simple step in the right direction.

1. Morrison BP, RN, FNP, CNM; Ludington-Hoe, Susan PhD, RN, CNM, FAAN. Interruptions to Breastfeeding Dyads in an LRDP Unit. American journal of Maternal Child Nursing 2012;37(1):36-41.

2. Morrison B, Ludington-Hoe S, Anderson GC. Interruptions to breastfeeding dyads on postpartum day 1 in a university hospital. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2006;35(6):709-716.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants.  I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating!  As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

Lactation Matters Editor’s Note: Just to add, Jennie has a brand new addition to the family.  Welcome Noah Lev, born on Oct 28, 2011, who is breastfeeding beautifully!  Congratulations !

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Is Pumping Out of Hand? Why Hand Expression in the First 3 Postpartum Days is Important

Stanford trained, Jane Morton, became a partner at the Palo Alto Medical Foundation, where she practiced general pediatrics and was repeatedly recognized by her colleagues as
one of the top pediatricians in the Bay Area.  She was invited to join the Stanford neonatology faculty to develop their Breastfeeding Medicine Program. She designed a nationally recognized educational program, published her original research and traveled extensively and internationally as an invited speaker.  At the 2011 ILCA Conference in San Diego, CA, Jane presented this plenary session titled, “Is Pumping Out of Hand?”

Jane Morton, MD
Cl Professor of Pediatrics
Stanford Pediatrics
www.burgesspediatrics.com
drjane@burgesspediatrics.com

A low milk supply is the most common reason for mothers to stop breastfeeding. (1.)  We have learned that what we do (or do not do) in the first 3 days after delivery can have a major impact on future milk production potential.  In our research, we found that milk production in pump-dependent mothers of preterm babies depended on the frequency they used hand expression in the first 3 days after delivery. (2.)  Mothers who used hand expression more than 5 times a day in the first 3 days yet pumped with the same frequency as other study mothers, expressed an average of 955 mls, about a quart a day by 8 weeks. This is more than a term 4 month old would need. Mothers also found consistent increases in production when they did not rely solely on pump suction alone to remove milk, but used “hands-on pumping”. This technique combines breast massage, compression and hand expression with electric pumping and does not require more time.  Of the 67 study participants, several volunteered to demonstrate hand expression and hands-on pumping on the Stanford website.  (3.)

For mothers of term and late preterm babies, there is an important role for an alternative way to remove colostrum when the infant has not yet learned to latch on and nurse effectively.  About 50% of mothers will have some difficulty getting their babies to latch on well in the first day. (4.) While providing a mother with a pump may be the easiest solution from the nursing standpoint, a recent study suggests it is more effective to teach her to hand express milk after breastfeeding. (5.) At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%). (p=0.02)

A smaller study suggests more milk can be removed with manual expression than with a new, double rental-grade pump in the first 48 hrs post partum. (6.) Given the feasibility and safety of spoon feeding, (7.) perhaps the routine practice in the first several days for infants at risk for suboptimal intake and/or mothers at risk for suboptimal milk production should be to encourage hand expression and spoon feeding after breastfeeding. This provides more milk for the baby and more stimulation to the breasts than breastfeeding alone. There seems to be no cost or risk and only potential benefit in this approach.

  1. Ruowei Li, Fein SB, Chen J,
    Grummer-Strawn L. Pediatrics 2008; 122(2):S69-S76.
  2. Morton J, J
    Perinatol. 2009 Nov;29(11):757-64. Epub 2009 Jul 2
  3. http://newborns.stanford.edu/Breastfeeding/  See: Hand
    Expressing Milk — video
    and Maximizing via Katy TX
    Milk Production — video
    . Complete video, Making Enough Milk, the Key to Successful Breastfeeding, can be
    previewed and purchased at www.breastmilksolutions.com
    . Soon available in Spanish
  4. Dewey KG.
    Risk Factors for Suboptimal Breastfeeding Behavior, Delayed Onset of Lactation
    and Excess Neonatal Weight Loss. Pediatrics 2003;112:607-619
  5. Flaherman VJ, Archives of Disease in
    Childhood 2011
  6. Ohyama M. Pediatr Int. 2010
    Feb;52(1):39-43
  7. Kumar A. J Perinatology 2010;
    30:209-217
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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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