Intention and practice on breastfeeding among pregnant mothers in Malaysia and factors associated with practice of exclusive breastfeeding: A cohort study

Background Exclusive breastfeeding rate in Malaysia is low despite its known health benefits. This study aims to determine the prevalence of intention to breastfeed among pregnant mothers, the prevalence of exclusive breastfeeding practice after delivery, and factors associated with exclusive breastfeeding practice. Methods This was a prospective cohort study. All pregnant women at 36 weeks gestation or above from 17 antenatal health clinics in an urban district were invited to participate in the study. A self-administered questionnaire was used, encompassing sociodemographic, breastfeeding knowledge, attitude, and intention towards the practice of breastfeeding. The participants were followed up one month post-natal for their practice of breastfeeding via telephone or during their post-natal follow-up appointment. Results 483 pregnant mothers participated in the study initially. 462 (95.7%) were contactable after one month. 99.4% (459/462) of participants intended to breastfeed. 65.4% (302/462) of participants practiced exclusive breastfeeding. There was no significant association between intention and practice of exclusive breastfeeding. Multiple logistic regression analysis shows, pregnant mothers with high breastfeeding knowledge (AOR = 1.138; 95% CI 1.008–1.284) and Malay ethnicity (AOR = 2.031; 95% CI 1.066–3.868) were more likely to breastfeed their infant exclusively. Conclusions Prevalence of exclusive breastfeeding practice at one month in the studied district was 65.4%. Malay mothers and mothers with high breastfeeding knowledge were more likely to breastfeed exclusively. Thus, we recommend targeted intervention towards non-Malay mothers and increasing breastfeeding knowledge to all pregnant mothers.

Knowledge, Attitude and Practices of Breastfeeding Among Mothers of Children Under 6 Months of Age in Suva, Fiji

Breastfeeding is a cost-effective public health approach that decreases infant and child morbidity and mortality. Fiji's exclusive breastfeeding rate was 40 percent compared to the global target of 50 percent. The research aims to evaluate mothers’ breastfeeding infants' level of knowledge, attitudes, and practice less than 6 months of age in Suva. A descriptive quantitative cross-sectional study was carried out in 3 randomly selected medical areas in Suva, Fiji. Knowledge, attitude, and practice (KAP) questionnaire was used to gather data from 415 mothers. The overall mean scores for breastfeeding knowledge of mothers were 12.9, the attitude was 33.7, and practice 7.20. Results showed that mothers were generally found to have good levels of knowledge and practice but a fair attitude. Knowledge was associated with the number of children that mothers had and ethnicity. Attitude had a positive correlation with household income. The practice was positively correlated with the mother's status of employment, the number of children, ethnicity, marital status, and household income. To improve breastfeeding knowledge, attitude and practices of mothers, awareness and education should be strengthened in all health facilities. Improvement in health education materials and advocacy is required.

Early Initiation of Breastfeeding up to Six Months and Breastfeeding Experience of Mothers who had Cesarean Section: A Scoping Review

Background: Breastfeeding is a gold nutritional feeding for the infant for optimal growth and development. Early initiation of breastfeeding is an important initial step for successful continuing breastfeeding. Cesarean section (C-section) has been reported to have negative effects on early initiation of breastfeeding. However, no current literature summarized the breastfeeding rate after C-section and vaginal delivery globally. Therefore, this scoping review aimed to systematically collect, assess, and map the existing literature regarding the rate and experience of breastfeeding of mothers after C-section.Design: We conducted a scoping review in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR) statement.Methods: We performed an electronic database search on Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, Cochrane Library, and PsychINFO on March 16, 2021. The inclusion criteria were (a) research, experiential, and case reports; (b) reports on the rate of breastfeeding after C-section and vaginal delivery; (c) qualitative studies on the experience of breastfeeding after C-section.Results: The search identified 4635 potentially relevant articles. After screening, 27 articles (24 quantitative and three qualitative studies) were included in the scoping review from 1990 to 2020. Most studies reported a higher breastfeeding rate in mothers who had vaginal delivery than in mothers who had C-Section at breastfeeding initiation, hospital discharge, one month, three months, and six months postoperatively. A large difference in breastfeeding rate was found at early breastfeeding initiation between the vaginal delivery and C-section groups. Most studies showed a breastfeeding rate of more than 30% at late breastfeeding initiation, one month, and three months after C-section. A mother’s physical discomfort, low self-efficacy, and lack of knowledge, and the insufficient support from healthcare providers were identified as breastfeeding barriers after C-section.Conclusions: The rate of breastfeeding after C-section has remained low to date. Lack of breastfeeding knowledge and insufficient healthcare provider support after C-section are the common underlying issues. Approaches to enhance breastfeeding must be developed and consistently implemented.

Effect of Kangaroo Mother Care on the Likelihood of Breastfeeding from Birth up to 6 Months of Age: A Meta-analysis

Background. One of the World Health Organization (WHO) nutrition target by 2025 is 50% exclusive breastfeeding rate among infants until age 6 months. Kangaroo mother care (KMC) known to increase breastfeeding rates, especially in preterm and low birth weight (LBW) infants. Objectives. This study determined the effect of KMC to the rate of exclusive breastfeeding among preterm and LBW infants at 6 months of age. Methods. Conducted searches in MEDLINE and CENTRAL databases, likewise hand searched local publications December 1996 until June 2018. Included several randomized controlled trials and prospective observational studies comparing KMC and conventional care among preterm and LBW infants. The primary outcome was exclusive breastfeeding of infants at six months of age. Two authors independently assessed trial quality and extracted data the statistical analysis applied using Review Manager version 5.3. Results. Identified nine eligible trials involving 1,202 neonates. All studies had low-to-moderate risk of bias. KMC significantly noted to increase the likelihood of exclusive breastfeeding by 1.9 times at birth up to 6 months (OR 1.93 [1.18,3.17], p=0.009). Conclusion. KMC can increase exclusive breastfeeding among preterm and LBW infants from birth up to 6 months of age.

Trends and Determinants in Breastfeeding among Korean Women: A Nationwide Population-Based Study

Many efforts have been launched to promote breastfeeding in Korea. However, breastfeeding trends and associated factors with breastfeeding in Korea remain unknown. This study aimed to examine trends and determinants in breastfeeding using the Korea National Health and Nutrition Examination Survey (KNHANES) (2010–2018). We analyzed data from the KNHANES V (2010–2012), VI (2013–2015), and VII (2016–2018). A total of 9232 women aged 19–49 years were included in this study. We performed multivariable logistic regression analyses to investigate breastfeeding prevalence trends and associated factors with breastfeeding. Compared to 2010–2012, the odds ratio associated with breastfeeding during 2013–2015 and 2016–2018 increased to 1.30 (95% confidence interval (CI): 1.11–1.51) and 1.40 (95% CI: 1.21–1.63), respectively. The breastfeeding rate was associated with 40–49 years (OR, 95% CI: 0.47, 0.34–0.64 compared to 19–29 years), richer and poorer income (1.20, 1.03–1.39 in richer group and 1.24, 1.05–1.46 in poorer group compared to richest group), education level (0.74, 0.65–0.86 in ≤12 years of education compared to ≥13 years of education), smoking status (1.77, 1.38–2.28 in non-smoking compared to smoking), and self-rated health (1.40, 1.14–1.70 in good and 1.20, 1.00–1.44 in average compared to bad). Education programs and policies such as the Baby-Friendly Hospital Initiative (BFHI) and mother-friendly workplaces are necessary to increase the rates of breastfeeding in these groups.

Acupuncture to Boost Breast Milk in Postpartum Hypogalactia: Randomized Controlled Trial

Background: Breast milk is appropriate and useful but the exclusive breastfeeding rate in Thailand was quite low at only 23.1%. Hypogalactia is one of the important barriers of breastfeeding. Studies in Asia and the west have shown that acupuncture could boost breast milk. However, some articles had controversial result. There has been no study to assess efficiency of acupuncture in early postpartum hypogalactia. Objective: To compare the efficacy of acupuncture and conventional treatment for stimulating breast milk in early postpartum hypogalactia at 48 hours. Materials and Methods: A randomized, prospective, clinical trial was used for the present study. Sixty postpartum hypogalactic women of term gestation in postpartum ward in Charoenkrung Pracharak Hospital between March 1, 2020 and February 28, 2021 were enrolled. They were randomized into acupuncture and control groups. In the study group, mothers received once a day acupuncture at 13 acupoints without electrode for three consecutive days by qualified Traditional Chinese Medicine practitioner other than conventional treatment. Breast milk quantity were measured at day 1, day 7, and day 14 after the intervention. Results: Mean age of all participants was 29.72±5.96 year, mostly primigravida, delivered by vaginal route. Mean milk volume in the treatment group were significantly higher than the control group (p<0.05) with day 1 at 19.00±22.25 versus 5.97±6.08 mL, day 7 at 78.10±60.38 versus 40.17±28.82 mL, and day 14 at 128.33±64.86 versus 75.00±57.96 mL. The amount of breast milk in the treatment group were 3-fold, 2-fold, and 1.7-fold times more than the control group at day 1, day 7, and day 14, in respective order (p<0.05). Conclusion: Accurate acupuncture intervention could boost breast milk production in early postpartum hypogalactia at 48 hours. Keywords: Postpartum hypogalactia; Acupuncture; Traditional Chinese Medicine (TCM)

Lactation counseling for maintaining exclusive breastfeeding in adolescent mothers: a trial protocol

Background Adolescent mothers have lower rates of initiation, continuation, and exclusivity of breastfeeding, and even more so in the first pregnancy. Current interventions target adult women, and little evidence is available for breastfeeding promotion among adolescents. Methods This is a pilot study protocol with a parallel, single-blind, randomized, and controlled trial design, to evaluate the feasibility of the intervention “Lactation Counseling” in first-time adolescent mothers to maintain exclusive breastfeeding in the first 6 months of life. The control group will receive routine education in prenatal care and prenatal and childbirth classes, the experimental group will receive additionally the intervention “Lactation Counseling”, for 4 weeks, both conducted by trained nurses. Feasibility outcome includes recruitment and dropout rates, and, pilot outcomes will be the exclusive breastfeeding rate and the breastfeeding knowledge. Measurements will be taken at baseline, post-intervention, and 2, 4, and 6 months after childbirth. Discussion Exclusive breastfeeding rates could be increased in adolescent mothers through nursing counseling interventions that are previously structured and evaluated from their feasibility. This study will allow the evaluation of the feasibility of an intervention in low-income, Latin American population adolescents. Trial registration ClinicalTrials.gov NCT04655846, Registered 7 December 2020.

Exclusive breastfeeding in rural Western China: does father’s co-residence matter?

Background China suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father’s co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father’s co-residence and breastfeeding family support as well as maternal decision-making power. Methods A cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding. Results The exclusive breastfeeding (0–6 months) rate was 16% in rural western China. Fathers’ co-residence was associated with a lower exclusive breastfeeding rate (OR = 0.413, 95% CI = 0.227–0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally (β =0.109, P = 0.105; β =0.011,P = 0.791, respectively) and it reduced maternal decision-making power (β = − 0.196, P = 0.007). Conclusions Fathers’ co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father’s education to help them better involvement and show more respect to mothers’ decisions.

Breastfeeding Supportive Services in Baby-Friendly Hospitals Positively Influenced Exclusive Breastfeeding Practice at Hospitalization Discharge and Six Months Postpartum

Background: Studies have shown that implementing the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative can protect, promote, and support breastfeeding. However, few studies have valuated the quality of breastfeeding supportive services provided by Baby-Friendly Hospitals from the perspective of service users. Methods: This was a hospital-based prospective study, conducted at eight Baby-Friendly Hospitals with a total of 707 pregnant women in Shanghai, China between October 2016 and September 2021. Breastfeeding supportive services during hospitalization were assessed at childbirth discharge using a 12-question questionnaire based on the Chinese “Baby-Friendly Hospital Evaluation Standards”. Women were followed up on six months postpartum. The impact of breastfeeding supportive services during hospitalization on the exclusive breastfeeding at discharge and six months postpartum were assessed. Results: Of the 707 mothers who completed the survey at discharge, 526 were followed up on six months after delivery. The overall exclusive breastfeeding rate among participants was 34.4% at discharge and 52.1% at six months postpartum. Mothers who received better breastfeeding supportive services during hospitalization were more likely to practice exclusive breastfeeding at hospitalization discharge compared with mothers who received poorer services (aOR: 3.00; 95% CI: 2.08, 4.35; p < 0.001). Furthermore, they were also more likely to exclusively breastfeed at six months postpartum (aOR: 1.50; 95% CI: 1.03, 2.22; p = 0.033). Conclusion: Better breastfeeding supportive services during hospitalization were significantly associated with higher rate of exclusive breastfeeding at discharge and six months postpartum. More effective measures should be adopted to improve the implementation of the breastfeeding supportive services in Baby-Friendly Hospitals to promote exclusive breastfeeding and better maternal and child health.

Impact of Neonatal Frenotomy on the Breastfeeding Rate at Discharge from the Maternity Ward: A Prospective, Cohort Study

Background Ankyloglossia may lead to an early abandonment of breastfeeding. Performing a frenotomy could increase the breastfeeding rate at discharge from the maternity ward. Methods This prospective cohort study included all the neonates born in our center in 2018 (1392). We offered a frenotomy to all tongue-tied patients. We determined how many frenotomies we performed (422), whether breastfeeding improved in the short term, and compared the breastfeeding rates between treated and untreated tongue-tied and non-tongue-tied neonates. Quantitative variables were described using the mean and standard deviation, and compared using a Student’s t-test. Rates of breastfeeding were compared using the Pearson chi square. Significance was set at the p < 0.05 level. Results The breastfeeding rate at discharge was higher among tongue-tied infants (92.1%) than non-tongue-tied (84.2%), and higher among treated than untreated neonates (93.1 vs 75.9%, respectively). Conclusions Frenotomy could help increase the breastfeeding rate at discharge among tongue-tied neonates. Trial registration: Not applicable