International Breastfeeding Journal - Latest articles

Assessing midwives' breastfeeding knowledge: Properties of the Newborn Feeding Ability questionnaire and Breastfeeding Initiation Practices scale

Debra K Creedy, Ruth M Cantrill and Marie Cooke — 2008-04-30

Background: There are few reliable and valid tools to assess lactation and infant feeding knowledge and practices. This study tested the psychometric properties of two new scales, the Newborn Feeding Ability (NFA) questionnaire and Breastfeeding Initiation Practices (BIP) scale to assess midwives' breastfeeding knowledge and practices specific to breastfeeding initiation. Methods: A national postal survey of Australian midwives (n = 3500) was conducted in October 2001. Reliability was determined through Cronbach's alpha coefficient and stability determined by a test-retest. Content validity was established through a critical review of literature and review by an expert panel. Construct validity was informed by an exploratory factor analysis and principle component analysis with varimax rotation. Correlations between NFA and BKQ knowledge subscale scores and BIP and BKQ practice subscale scores assessed criterion validity. A multiple hierarchical regression analysis determined predictive validity of the NFA and BIP. Results: A response rate of 31.6% (n = 1107) was achieved. Adequate internal consistency was established for both instruments. Five factors on the NFA questionnaire were congruent with knowledge about effects of skin-to-skin contact, physiological stability, newborn innate abilities, work practices and effective breastfeeding. The BIP revealed three factors related to observing pre-feeding behavior, mother/baby care and attachment and positioning practices. Predictive validity of knowledge was moderate (r = 0.481, p < 0.01) and contributed to 31.5% of variance in reported practice. Midwives with high knowledge scores were more likely to report best practice when assisting mothers to initiate breastfeeding. Midwives with more personal breastfeeding experience scored higher on all scales. Conclusion: The Newborn Feeding Ability questionnaire and the Breastfeeding Initiation Practices scale can contribute to practice development by assessing lactation and infant feeding knowledge and practice deficits. Individual learning needs can be identified, and effectiveness of education interventions evaluated using these tools. Further testing is required with other samples of midwives and health professionals involved in the promotion of breastfeeding.

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment

2008-04-07

Background: The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts. Methods: In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms. Results: Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 107 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003). Conclusion: Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.

Antenatal counseling on breastfeeding – is it adequate? A descriptive study from Pondicherry, India

2008-03-04

Background: Antenatal counseling on breastfeeding and postnatal lactation support are likely to improve rates of exclusive breastfeeding. This descriptive study was undertaken to assess whether antenatal visits were utilized for promotion of exclusive breastfeeding in addition to the routine obstetric services. Methods: This descriptive study was conducted at a tertiary hospital in Pondicherry, India. Every third primigravida mother admitted in the maternity ward from June to December 2005 was recruited. Among these 144 primigravida mothers, 108 who had a minimum of three antenatal visits ("booked") were included in the study. These 108 mothers were administered a pre-tested semi-structured questionnaire on breastfeeding in the local language, Tamil, within 24 hours of giving birth. Appropriate flash cards with pictures were also used while administering the questionnaire. The awareness among mothers (both "counseled" and "not counseled") regarding health information pertaining to breastfeeding was assessed. Results: Of the booked mothers, 21% (n = 23) had received some antenatal counseling about breastfeeding while 79% (n = 85) had not received any such counseling. Four percent had undergone breast examination during antenatal visits. Awareness related to breastfeeding among mothers in the "counseled" group was better than those in the "not counseled" group. Even in the "counseled" group, awareness among mothers with regard to correct breastfeeding technique and concept of continuing breastfeeding during illness in the baby was no different from those in the "not counseled" group. Conclusion: Existing antenatal counseling on breastfeeding is inadequate in the population studied and needs to be strengthened. Informing all pregnant women about the benefits and management of breastfeeding should be a priority during antenatal visits.

A cohort study of infant feeding practices in city, suburban and rural areas in Zhejiang Province, PR China

Liqian Qiu, Yun Zhao, Colin W Binns, Andy H Lee and Xing Xie — 2008-03-03

Background: Breastfeeding is the basis for appropriate nutrition for infants and is strongly supported by the Ministry of Health in China. However, there are differences in infant feeding practices in different areas of the country. The aim of this study was to compare the infant feeding practices and the prevalence of determinants of initiation and continuing to breastfeed until six months of age in city, suburb and rural areas in Zhejiang Province, PRC. Methods: A longitudinal cohort study of infant feeding practices was undertaken in city, suburban and rural areas in 2004/2005. Mothers were recruited and interviewed before discharge from hospitals. A total of 1520 mothers were recruited into the study. Follow-up interviews were administered at 1, 3 and 6 months after birth to obtain details of infant feeding practices. Results: 'Any breastfeeding' rates were high before discharge at all three locations, 96.5% in city, 96.8% in suburb and 97.4% in the rural area. The 'exclusive breastfeeding' rates in the city, suburban and rural areas before discharge were 38.0%, 63.4% and 61.0% respectively. By sixth months the 'any breastfeeding' rates had declined to 62.8%, 76.9% and 83.6% and the 'exclusive breastfeeding' rates had fallen to 0.2%, 0.5% and 7.2% in city, suburb and rural areas respectively. There were differences in feeding practices between the three locations, including the use of prelacteal feeds and the introduction of supplementary feeds. Conclusion: Mothers who lived in the city were least likely to be 'exclusive breastfeeding' at discharge. At six months the city infants also had lower rates of 'any breastfeeding' and 'exclusive breastfeeding'.

A prospective study of iron status in exclusively breastfed term infants up to 6 months of age

Shashi Raj, MMA Faridi, Usha Rusia and Om Singh — 2008-03-01

Background: Can exclusive breastfeeding until six months of age maintain optimum iron status in term babies? We evaluated iron status of exclusively breastfed term infants in relation to breast milk iron and lactoferrin. Methods: In this prospective study in Delhi, India, during the period 2003–2004 normally delivered babies of non-anemic [(Hemoglobin (Hb) = 11 g/dl, n = 68] and anemic (Hb 7 – 10.9 g/dl, n = 61) mothers were followed until 6 months of age. Iron parameters were measured in the cord blood at 14 weeks and 6 months. Breast milk iron and lactoferrin were measured at the same intervals. Results: Iron parameters in babies of both groups were within normal limits at birth, 14 weeks and 6 months. Mean breast milk iron and lactoferrin in non-anemic (day 1: 0.89, 6 months: 0.26 mg/l; day 1: 12.02, 6 months: 5.85 mg/ml) and anemic mothers (day 1: 0.86, 6 months: 0.27 mg/l; day 1: 12.91, 6 months: 6.37 mg/ml) were not different on day one or at other times. No relationship was found between breast milk iron, lactoferrin and iron status of the babies. Conclusion: Exclusively breastfed infants of non-anemic and anemic mothers did not develop iron deficiency or iron deficiency anemia by six months of age.

A descriptive study of Cambodian refugee infant feeding practices in the United States

Becky Straub, Cathy Melvin and Miriam Labbok — 2008-01-24

Background: The purpose of this exploratory study was to examine Cambodian refugee mothers' infant feeding beliefs, practices, and decision making regarding infant feeding in the U.S. and to explore if a culturally-specific breastfeeding program is appropriate for this community. Methods: A self-administered questionnaire and a 30 minute in-person interview were used to collect information from nine women. The audio-taped interviews were transcribed, answers compiled, and themes from each question identified. Results: All participants practiced either traditional Cambodian diet (pregnancy and postpartum diet including, tnam sraa, herbs mixed with either wine or tea), traditional Cambodian rituals (like spung, amodified sauna) or both, despite having lived in the U.S. for many years. All nine women initiated breastfeeding, however eight women introduced infant formula while in hospital. Perceived low milk supply and returning to work were the main reasons cited for partial breastfeeding and early cessation of breastfeeding. Conclusion: While causes of initiation of other foods are similar to those found in the U.S. as a whole, a culturally-specific Cambodian breastfeeding support program may help overcome some breastfeeding problems reported by Cambodian refugee mothers who have immigrated to the United States.

Initiation of breastfeeding within 120 minutes after birth is associated with breastfeeding at four months among Japanese women: A self-administered questionnaire survey

Yuko Nakao, Kazuhiko Moji, Sumihisa Honda and Kazuyo Oishi — 2008-01-10

Background: The proportion of mothers in Japan who breastfeed exclusively has been low since the 1970s. The purpose of this study was to examine the association between the time of first breastfeed after birth and the proportion of mothers fully breastfeeding up to four months postpartum. Methods: A survey was conducted using a self-administered questionnaire. The participants were 318 mothers who participated in a physical examination of their four month old infants in Nagasaki City, Japan in 2003. Results: The time of first breastfeeding up to 120 minutes was significantly associated with the proportion of mothers fully breastfeeding during their stay in the clinic/hospital (p = 0.006), at one month (p = 0.004) and at four months after birth (p = 0.003). There was no significant difference in the proportion of full breastfeeding in mothers who first breastfed between the period of less 30 minutes after birth and that of between 31 and 120 minutes after birth. Logistic regression analysis indicated that the proportion of mothers who continued full breastfeeding at four months was significantly higher in those who breastfed their baby within 120 minutes compared with more than 120 minutes (OR 2.5, p = 0.01), but was not significantly different in those who breastfed within 30 minutes compared with more than 30 minutes (OR 1.8, p = 0.06). Early breastfeeding was affected by caesarean section, premature delivery and severe bleeding during delivery. Conclusion: Commencement of early breastfeeding was associated with the proportion of mothers who fully breastfed their infants up to four months. Early breastfeeding, especially within two hours, is recommended for child and maternal health.

Infant feeding, poverty and human development

Annette Beasley and Lisa H Amir — 2007-10-22

The relationship between poverty and human development touches on a central aim of the International Breastfeeding Journal's editorial policy which is to support and protect the health and wellbeing of all infants through the promotion of breastfeeding. It is proposed that exclusive breastfeeding for 6 months, followed by continued breastfeeding to 12 months, could prevent 1,301,000 deaths or 13% of all child deaths under 5 years in a hypothetical year. Although there is a conventional wisdom that poverty 'protects' breastfeeding in developing countries, poverty actually threatens breastfeeding, both directly and indirectly. In the light of increasingly aggressive marketing behaviour of the infant formula manufacturers and the need to protect the breastfeeding rights of working women, urgent action is required to ensure the principles and aim of the International Code of Breastmilk Substitutes, and subsequent relevant resolutions of the World Health Assembly, are implemented. If global disparities in infant health and development are to be significantly reduced, gender inequities associated with reduced access to education and inadequate nutrition for girls need to be addressed. Improving women's physical and mental health will lead to better developmental outcomes for their children.

Breastfeeding practices in a public health field practice area in Sri Lanka: a survival analysis

Suneth B Agampodi, Thilini C Agampodi and Udage Kankanamge D Piyaseeli — 2007-10-11

Background: Exclusive breastfeeding up to the completion of the sixth month of age is the national infant feeding recommendation for Sri Lanka. The objective of the present study was to collect data on exclusive breastfeeding up to six months and to describe the association between exclusive breastfeeding and selected socio-demographic factors. Methods: A clinic based cross-sectional study was conducted in the Medical Officer of Health area, Beruwala, Sri Lanka in June 2006. Mothers with infants aged 4 to 12 months, attending the 19 child welfare clinics in the area were included in the study. Infants with specific feeding problems (cleft lip and palate and primary lactose intolerance) were excluded. Cluster sampling technique was used and consecutive infants fulfilling the inclusion criteria were enrolled. A total of 219 mothers participated in the study. The statistical tests used were survival analysis (Kaplan-Meier survival curves and Cox proportional Hazard model). Results: All 219 mothers had initiated breastfeeding. The median duration of exclusive breastfeeding was four months (95% CI 3.75, 4.25). The rates of exclusive breastfeeding at 4 and 6 months were 61.6% (135/219) and 15.5% (24/155) respectively. Bivariate analysis showed that the Muslim ethnicity (p = 0.004), lower levels of parental education (p < 0.001) and being an unemployed mother (p = 0.021) were important associations of early cessation of exclusive breastfeeding. At the time of the study, 62% (135/219) of infants were receiving feeds via a bottle and 23% (51/219) were receiving infant formula. Muslim ethnicity was significantly associated with bottle and formula feeding (p < 0.001). Bottle feeding was also significantly higher among mothers with a low level of education and among employed mothers. Conclusion: The rate of breastfeeding initiation and exclusive breastfeeding up to the fourth month is very high in Medical Officer of Health area, Beruwala, Sri Lanka. However exclusive breastfeeding up to six months is still low and the prevalence of inappropriate feeding practices is high.

Evaluation of a peer counselling programme to sustain breastfeeding practice in Hong Kong

2007-09-20

Background: Peer counselling is reported to increase breastfeeding rates. We evaluated an intervention consisting of mainly telephone contact peer counselling programme on breastfeeding duration and exclusivity. Methods: Peer counsellors (PCs) were mothers who had successfully breastfed and had received formal training. Following a postnatal visit, they provided scheduled telephone consultations (Days 1, 4, 7, Weeks 2, 4, 8, and Month 4) to PC group mothers (n = 100) who continued breastfeeding their infants after discharge. Control group mothers (n = 100) received routine care. Results: After adjusting for mothers' previous breastfeeding experiences, mothers' working status and breastfeeding problems, no statistical differences in mothers' feeding methods (exclusive, almost exclusive or predominant breastfeeding) were noted at the three follow-up times for intervention and control mothers respectively (Day 5: 37%/38%, 46%/53%, 57%/63%; Month 3: 10%/9%, 17%/23%, 20%/26%; Month 6: 2%/1%, 18%/18%, 18%/19%). All differences between the groups were not significant. Also, there was no evidence to suggest that PC intervention prolonged breastfeeding duration. Conclusion: The lack of effect of our PC intervention may reflect the low baseline breastfeeding rate and low value placed on breastfeeding in our population, the type of PC intervention or group allocation biases.Trial registrationISRCTN93605280.