Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam

Background: Breastfeeding brings benefits to both mothers and children in the short term and long term. Unnecessary cesarean sections can bring risks to both parties. This study was undertaken to examine the relationship between exclusive breastfeeding intention and cesarean delivery. Methods: We analyzed data collected from 554 single mothers who delivered in Dong Anh General District Hospital or Hanoi Obstetrics and Gynecology Hospital, Vietnam, in 2020–2021. The relationship between exclusive breastfeeding intention and cesarean delivery for nonmedical reasons was adjusted for maternal education, maternal age, parity, history of fetal loss, having at least eight antenatal contacts, hospital of delivery, child sex, and birth weight. Results: Antenatally, 34.8% (184/529) of mothers intended to breastfeed exclusively until 6 months and 30.8% (84/274) underwent cesarean section for a nonmedical reason. After adjusting for other factors, mothers who intended to breastfeed exclusively until 6 months were less likely to undergo cesarean delivery for nonmedical reasons (OR = 0.55, 95% CI: 0.31–0.96, p = 0.034). Conclusions: This study adds to the growing evidence related to unnecessary cesarean sections and routine over-medicalization of normal birth in the urban areas of Vietnam. The association between breastfeeding intentions and a lower rate of cesarean section suggests that education on breastfeeding could be a useful intervention for reducing the rate of cesarean sections and improving maternal and child health.

A qualitative exploration of mixed feeding intentions in first-time mothers

Background Breastfeeding intention can predict breastfeeding behaviour and is influenced by theory of planned behaviour constructs. Despite associations with reduced breastfeeding duration, there is a lack of research to explore the intention to mixed feed infants. Aims This study aimed to explore the factors that influence pregnant women's intentions to mixed feed their first child. Methods Semi-structured interviews were conducted with four women pregnant with their first child who intended to mixed feed. An in-depth idiographic multiple case study approach grounded in a ‘subtle realist’ epistemology was used. Results The interviews highlighted the importance of flexibility in feeding decisions, a perception of breastfeeding as restrictive and obstructive to normality and the presence of misinformation and unrealistic expectations about breastfeeding. Conclusions Women need to be informed and supported by professionals, peers, families and broader communities. Cultural narratives must be challenged to enable mothers to feel in control of feeding decisions and without the need to justify feeding activities to protect themselves from anticipated negative emotions.

Effects of the Experience of Breastfeeding-Friendly Practices and Breastfeeding Intention and Self-Efficacy on Breastfeeding Behavior: A Cohort Study in Taiwan

Background: Approximately 80% of births occurred in Baby-Friendly-accredited facilities in Taiwan, although the trend of exclusively breastfeeding infants until 6 months of age has stagnated in the last 10 years. To guide breastfeeding promotion interventions during postnatal stays and encourage mothers to continue breastfeeding for the first 6 months, the factors of breastfeeding behavior within 6 months post-delivery must be investigated. This study explored the relationships among breastfeeding intention, experience of breastfeeding-friendly practices, breastfeeding self-efficacy, and breastfeeding behavior at 4 and 6 months after childbirth.Methods: In this longitudinal cohort study, women who gave birth to healthy newborns at two Baby-Friendly hospitals in Taiwan and who were willing to breastfeed were recruited. Data were collected through a self-developed questionnaire measuring the experience of breastfeeding-friendly practices and through the Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form during hospitalization and at 1, 2, 4, and 6 months after childbirth.Results: A total of 155 women completed the questionnaires 5 times within 6 months. The determinants of exclusive breastfeeding at 4 months and any breastfeeding at 6 months were longstanding breastfeeding intention during hospitalization, a high score for the experience of breastfeeding-friendly practices, and a high level of breastfeeding self-efficacy during that period. The in-hospital experience of breastfeeding-friendly practices did not predict breastfeeding behavior at 4 and 6 months. Breastfeeding intention (hazard ratio [HR] = 0.40–0.14) and in-hospital breastfeeding self-efficacy (HR = 0.98) were significant as in-hospital risk factors contributing to breastfeeding duration 6 months after childbirth.Conclusions: Longstanding breastfeeding intention, continuation of the experience of breastfeeding-friendly practices, and maintenance of a high level of breastfeeding self-efficacy were the determinants of breastfeeding at 4 and 6 months. Healthcare professionals in Taiwan must support breastfeeding-friendly practices and consider interactive interventions to promote continued breastfeeding at different stages during the first 6 months after childbirth based on the mother’s informed plan of breastfeeding and breastfeeding self-efficacy during their postnatal hospitalization.

Breastfeeding Intention, Knowledge, and Attitude of Pregnant Women in Treatment for Opioid Use Disorder

Objective The objective of this study was to describe breastfeeding intention, knowledge, and attitude, and sources of infant feeding information during the prenatal period among a cohort of pregnant women in treatment for opioid use disorder (OUD). Study Design Pregnant women who were receiving treatment for OUD and in the third trimester completed a questionnaire that measured demographic characteristics, infant feeding intentions, breastfeeding beliefs and attitudes, and sources of breastfeeding information. Frequency counts and percentages and means and standard deviations were used to describe data. Results Sixty-five women completed the survey. Three-fourths reported some intention to breastfeeding. While attitudes around breastfeeding were generally positive, less than half of respondents knew the recommendations and infant health benefits of breastfeeding. Conclusion Prenatal programs for women in treatment for OUD should consider addressing patient-reported concerns and gaps in knowledge regarding the benefits of and recommendation for breastfeeding. Key Points

Breastfeeding experiences of women with gestational diabetes

Purpose: This study aimed to explore the lived experiences of breastfeeding women with gestational diabetes and to understand the meaning of breastfeeding for them and its encompassing context. Methods: Qualitative data were collected by interviewing 15 mothers with gestational diabetes. The transcript data from 5 focus group interviews and 2 individual interviews were analyzed using thematic analysis. Results: A core theme and 10 sub-themes emerged. The core theme that emerged was "the maternal commitment enabled for a limited time a way to compensate for guilt." Because mothers had to control their blood sugar levels before childbirth, they were worried about whether it would harm the newborn baby and thus searched for dietary information. After the babies were born and separated from their mothers, they were free from gestational diabetes. Mothers then felt guilty about their unhealthy bodies when they were pregnant. This regret provides a motivational context for breastfeeding. However, the mothers realized that breastfeeding requires commitment and dedication and that they need breastfeeding support, such as being provided practical help. Conclusion: The results showed that the breastfeeding intention of women with gestational diabetes might originate from their feelings of guilt. Therefore, an integrated breastfeeding program that combines the empathetic support of women with similar experiences and that shares practical information from experts should be implemented in a structured and systematic way.

A mixed-methods longitudinal study of Marshallese infant feeding beliefs and experiences in the United States: a study protocol

Background Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas. Methods The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers. Discussion Findings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas.

The Impact of Covid-19 On Maternal Delivery Experiences and Breastfeeding Practices in China: A Cross-Sectional Study

Background The COVID-2019 pandemic has placed extensive pressure on health systems and posed a severe public health challenge worldwide. Lockdown measures implemented in many countries have delayed virus spread. However, a considerable number of people have faced unprecedented pressure, especially the pregnant and breast-feeding women, because face-to‐face professional support has been reduced during the lockdown in many countries. Objectives To compare the delivery and infant feeding experiences of women who delivered before (BL) versus during (DL) the Covid-19 pandemic in Beijing, China. Methods Women aged ≥ 18 years with an infant ≤ 18 months of age completed an anonymous survey. Information/links were shared online and via local clinics in Beijing. Logistic regression was performed to assess predictors of breastfeeding during the first 6-months. Results 2233 women provided data; BL 1241 (55.6%), DL 992 (44.4%). The 6-month mostly breastfeeding (MBF, mainly breastfeeding with few non-formula fluids added) rate was significantly higher in the DL mothers (71.6%), compared to the BL mothers (60.6%). MBF was predicted by delivery during the lockdown period (OR1.42, 95% confidence interval 1.06, 1.90), younger maternal age, discussing infant feeding in a feeding support group, and getting support from friends or relatives. Moreover, relative to those little affected by COVID, those who were much affected were less likely to MBF. Conclusion The COVID-19 pandemic and lockdown measures influenced mothers’ planned birth location and breastfeeding intention. However, breastfeeding practice was maintained during the pandemic. The reported breastfeeding rates were high and our results highlight the importance of feeding support as well as potential beneficial effects of increased mother-infant contact during the lockdown period which is relevant even under normal circumstances.

Younger Age in Adolescent Pregnancies Is Associated with Higher Risk of Adverse Outcomes

Adolescent pregnancy remains a health issue worldwide also in developed countries, since it has been associated with adverse maternal and neonatal outcomes. Some data suggest that very young adolescents have higher risk, likely due to immaturity. Therefore, we aimed to assess the influence of maternal age on complications during gestation and labor in pregnant women between 13 and 19 years of age. In particular, we evaluated the possible association between maternal age and obstetric, fetal and labor complications. This is a retrospective, observational and exploratory study conducted at Hospital Universitario La Paz (HULP, Madrid, Spain). The clinical history of 279 women who delivered between 2013 and 2018 was analyzed. Maternal age and the presence of maternal, fetal and labor complications, as well as risk of postpartum depression and breastfeeding intention, were recorded. General regression models were used to analyze the contribution of maternal age on each complication. The percentage of adolescent pregnancies at HULP between 2013 and 2018 was 0.9%. The risk of all the maternal complications analyzed decreased significantly with every year of age of the mother (hyperemesis, lower back pain, anemia, gestational diabetes mellitus, and threat of premature labor and premature rupture of membranes). Every year of maternal age decreased 0.8-fold [0.8; 0.9] the prevalence of fetal complications and also reduced the risk of C-section, postpartum hemorrhage and obstetrical hysterectomy. Furthermore, higher maternal age increased 1.1-fold [1.0; 1.2] the breastfeeding intention. In conclusion, young adolescents are at higher risk of complications during pregnancy and labor.

Breastfeeding Motivation Predicts Infant Feeding Intention and Outcomes: Evaluation of a Novel Adaptation of the Treatment Self-Regulation Questionnaire

Background: Identifying those at risk for suboptimal breastfeeding outcomes remains critical for improving maternal and child health. Prenatal breastfeeding motivation may be a key predictor useful for identifying those who would benefit from additional breastfeeding support. Research Aims: To (1) validate a breastfeeding-specific adaptation of the Treatment Self-Regulation Questionnaire (TSRQ-BF); and (2) determine if breastfeeding motivation predicts prenatal breastfeeding intentions and early breastfeeding outcomes. Methods: Participants in their third trimester of pregnancy ( N = 150) completed several instruments, including the TSRQ-BF and infant feeding intention, and could opt to participate in an assessment of early breastfeeding outcomes (by medical record review). TSRQ-BF subscales were derived from factor analysis, and multivariable regression was used to evaluate the association between TSRQ-BF subscale scores and breastfeeding intention and outcomes during the birth hospitalization. Results: Autonomous (related to personal values/beliefs regarding self) and Autonomous-Baby (values/benefits for the infant) subscale scores were positively associated with intended exclusivity (aOR [95% CI]: 2.22 [1.57, 3.30], 4.94 [2.49, 11.07], respectively) while higher scores on these subscales predicted longer time to planned cessation (aHR [95% CI]: 0.72 [0.61, 0.84],0.52 [0.34, 0.81]). Higher Amotivation (lack of motivation) scores were negatively associated with intended exclusivity (0.45 [0.26, 0.74]). Higher scores on Autonomous, Autonomous-Baby, and Controlled (avoidance of negative feelings/punishment or gaining reward) subscales were associated with greater odds of hospital exclusivity (aOR [95% CI]: 3.39 [1.75, 8.00], 3.44 [1.66, 9.04] and 6.05 [1.88, 29.04]) and lower odds of 2-day formula supplementation (aOR [95% CI]: 0.31 [0.14, 0.59],0.28 [0.11, 0.59], 0.19 [0.04, 0.62]). Conclusions: The TSRQ-BF predicted breastfeeding intent and outcomes, and may be helpful for identifying patients at risk for suboptimal breastfeeding outcomes before delivery.

Analysis of Prenatal Breastfeeding Self-Efficacy and Anxiety Surrounding Giving Birth During COVID-19 Among Pregnant Women in the United States

Objectives To assess the relationship between perceived level of anxiety and concern with giving birth during COVID-19 and level of prenatal breastfeeding self-efficacy among a sample of pregnant persons in the United States. Methods A sample of 849 pregnant persons, representing all 50 states and 5 US territories, were recruited via social media advertisements to take a 78-item web-based survey between May and December of 2020. The survey items assessed prenatal breastfeeding self-efficacy using the valid PREP to BF scale, breastfeeding intention, anxiety with giving birth during COVID-19, concern for the baby being exposed at birth, and confusion with pregnancy recommendations during COVID-19. Results The sample, mean age 28.9 years, had a relatively high mean PREP to BF score (308.52 ± 62.74; range 39–390). Over 95% indicated a plan to incorporate breastmilk into their infant feeding routine either exclusively (68.96%) or in combination (26.5%). Seventy-one % were not confused by safe pregnancy recommendations, while 50.7% were “concerned” or “very concerned” their baby would be exposed to COVID-19 at birth, and 63.3% indicated they were “anxious” or “very anxious” about giving birth during the pandemic. One-way ANOVAs revealed persons with higher perceived anxiety (P = .024), more confusion over recommendations (P < .001), and more concern for their baby's exposure (P = .002) had significantly lower PREP to BF scores than their counterparts. Conclusions A pregnant person's anxiety, confusion over recommendations, and concern for their baby's safety had significant negative effects on prenatal self-efficacy for successful breastfeeding after birth during COVID-19. Prenatal healthcare teams should aim to discuss these aspects and reassure of proven safety protocols with pregnant patients to ease anxiety, confusion, or fear while helping to maintain or improve self-efficacy for the intended infant feeding method. Funding Sources This material is based upon work supported by the National Institute of Food and Agriculture, US Department of Agriculture, Hatch project LAB94426.