“It Is a Very Emotional Topic for Me”—Managing Breastfeeding Problems among German Mothers: A Qualitative Approach

Breastfeeding is associated with positive health outcomes for both child and mother. Nevertheless, some women experience breastfeeding problems which commonly lead to early cessation, or not starting breastfeeding at all. Our aim was to explore how women that have difficulties in breastfeeding perceive their situation and how they actively manage it. We conducted semi-structured interviews with 15 mothers living in Germany who had experienced breastfeeding problems. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Breastfeeding problems occurred due to different reasons and had a huge impact, as evidenced in the four main themes of the findings: individual situation, managing the situation, perceived consequences for relations, feelings, and potential future pregnancies, and perceived health consequences for the mother. They frequently experienced negative emotions, including psychological distress and mental health problems, with perceived negative consequences for the mother–infant-bonding. Trying to actively manage the situation and availability of social support seemed to have a relieving effect, whereas confrontation and lack of understanding worsened the situation. Breastfeeding problems and the inability to breastfeed can have a great influence on maternal well-being. These can affect different aspects of a mother’s life, including the attachment to the child. Providing support for actively managing the situation and supporting the exchange of experience between mothers who perceive breastfeeding problems may help mothers to better deal with their situation. Our findings may help health professionals to understand what these mothers feel and how they can support these women in a sensitive way.

The Role of Mixed-feeding in Undermining Breastfeeding: Analysis of the 2018 Scottish Infant Feeding Survey

Objectives Mixed-feeding (MF), the use of formula with breastfeeding is commonly followed by early breastfeeding cessation, but the actual mechanism for this is not yet clear. We aimed to investigate i) the reasons why breastfeeding mothers start mixed feeding, ii) its association with later lactation, and iii) the role health staff play in discouraging mixed-feeding and supporting continued breastfeeding. Methods Participants were mothers in the Scottish Maternal and Infant Feeding Survey (2018) cohort, who had ever breastfed their infants and completed questionnaires at infant age 8–12 weeks, reporting on feeding intentions, feeding practice, breastfeeding problems, reasons for use of formula and sociodemographic data. Mothers who planned to mixed-feed from the outset, were defined as early MF, while those who had not intended to mixed feed but did so, were defined as reactive MF. Results Of 1974 initially breastfeeding mothers, 65% had mixed-fed at some point. At 6 weeks, 32% had ceased breastfeeding, 22% were mixed-feeding and 46% were still exclusively breastfeeding. Early breastfeeding problems (<2 weeks) were common (65%) and related to stopping breastfeeding (Relative Risk [RR]:3.23, 95% Confidence Interval [CI]: 2.0, 5.3). Using survival modelling, adjusting for early and late breastfeeding problems, and sociodemographic factors, reactive MF were less likely than early MF to have stopped breastfeeding (Hazard Ratio [HR]:0.57, 95% CI: 0.4, 0.8). In multivariate analysis, increased risk of breastfeeding cessation was associated with intention to mixed-feed (RR:3.39, 95%CI: 2.4, 4.9), and introduction of formula due to convenience (RR:3.21, 95%CI: 2.3, 4.4); the latter was also associated with later lactational issues (RR:1.76, 95%CI: 1.3, 2.3). Mothers who received specialist lactation support were less likely to cease breastfeeding (RR:0.63, 95%CI: 0.5, 0.9) but other input was not protective. Conclusions Mothers often choose to mix-feed their infants from the first weeks, even in absence of breastfeeding problems. Maternal and child health programs need to counsel mothers against mixed-feeding and provide skilled help for breastfeeding issues. Funding Sources N/A.

Assessment Indicator from Grandmothers' Support Was the Strongest Correlation to Non-Exclusive Breastfeeding Practice in Young Primiparous Working Mothers

Primiparous mothers will experience various breastfeeding problems because it is the first experience, especially for working mothers. Therefore, they need to get support from their families, mainly from grandmothers. This study aims to analyze the correlation between the grandmother's support and exclusive breastfeeding for primiparous mothers working. This study, conducted in the Arjowinangun Community Health Center coverage area, Malang, used a cross-sectional study approach. The data collection used purposive sampling and questionnaires. One hundred thirty-two respondents had agreed to participate in this study. The results show that most mothers who choose non-exclusive breastfeeding had received insufficient support. There was a significant and strong correlation between grandmother's support and breastfeeding behavior (p-value = 0.000; r = 0.831), which means that the better the grandmother's support, the better exclusive breastfeeding behavior primiparous working mothers. All the support indicators were sufficient categories. The assessment support was the highest correlation to non-exclusive breastfeeding (r = 0.649). The conclusion is grandmother's support has a significant role in the success of exclusive breastfeeding for working mothers, so breastfeeding assistance by health workers should focus on mothers and families, especially grandmothers.

Prevalence and the Determinants of Traditional, Complementary, and Integrative Medicine Use Among Breastfeeding Mothers in Shiraz, Iran: a Cross-section Study

Background: Breastfeeding is highly important for a child's health, and the widespread use of herbal medicines as galactagogues has been reported. The present study was conducted to evaluate the use of traditional, complementary, and integrative medicine (TCIM) and its determinants among breastfeeding mothers in Shiraz, Iran.Methods: In this cross-sectional study, mothers over 18 years who referred to neonatal clinics affiliated to Shiraz University of Medical Sciences were enrolled. Using a structured interview, we explored the prevalence and of the use of TCIM products and its associated factors. Results: Out of 625 mothers who were approached, 483 agreed to participate (response rate: 77.3%). The average age was 27.3 ± 5.9 years. The prevalence of using TCIM products during current breastfeeding was 97.1%. There were 168 working mothers (44.9%); 163 mothers (34.1%) complaining of postpartum breastfeeding problems, and 327 mothers (68%) had no past history of breastfeeding. Recommendations of medical staff or relatives were the most frequent reasons for the consumption of TCIM products (64.9%). Only 27% of mothers disclosed the use of TCIM products to their doctor or healthcare provider, although 62% of mothers were asked about the use of such products. Notably, 438 mothers (95.8%) considered TCIM to increase their milk. Based on multivariable logistic regression, literacy and past use of TCIM galactagogues were independently associated with TCIM products use.Conclusions: The use of TCIM galactagogues is highly common among breastfeeding mothers in south of Iran, showing a diverse range of determinants. It is necessary to evaluate the safety and efficacy of common herbal galactagogues, and evidence-based studies must be designed to achieve standardized complementary medicine approaches in this regard.

Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study

Objectives To assess the Efficacy of Frenotomy with regard to Breastfeeding and Reflux Improvement (BRIEF) in infants with breastfeeding problems. Materials and methods A cohort of 175 consecutive breastfeeding women with breastfeeding and reflux problems related to a tongue-tie or lip-tie fulfilling the inclusion criteria was longitudinally followed for 6 months. The effect of frenotomy on these problems was studied by a standardized oral assessment and completing the validated Breastfeeding Self-Efficacy Short Form (BSES-SF), nipple pain score (Visual Analogue Scale, VAS), and Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) questionnaires pre-frenotomy and at 1 week, 1 month, and 6 months’ post frenotomy. Results All 175 women completed the 1-month follow-up and 146 women the 6 months’ follow-up. Frenotomy resulted in a significant improvement of BSES-SF, nipple pain score, and I-GERQ-R after 1 week, which improvement maintained to be significant after 1 month for BSES-SF and I-GERQ-R, and after 6 months for I-GERQ-R. The improvements were irrespective of the type lip-tie or tongue-tie underlying the breast feeding and reflux problems. No post-operative complications were observed. About 60.7% of infants still was breastfed 6 months after treatment. Conclusions Frenotomy is a safe procedure with no post-operative complications and resulting in significant improvement of breastfeeding self-efficacy, nipple pain, and gastro-oesophageal reflux problems. Clinical relevance Frenotomy of a tongue-tie and or lip-tie can lead to improvement of breastfeeding and reflux problems irrespective of the type of tongue-tie or lip-tie and should be considered by clinicians as a proper tool to resolve these problems if non-interventional support did not help. International trial register ISRCTN64428423

THE EFFECT OF COMBINATION OF MARMET TECHNIQUES AND WARM COMPRESSES ON PRODUCTION ASI IN POSTPARTUM MOTHER IN INDEPENDENT MIDWIFE PRACTICE DINCE SAFRINA PEKANBARU CITY

Breastfeeding problems that can arise from the first day to the third daypostpartum is ASI not streamlined. ASI does not streamlined make themother unable to meet the needs of the baby. The purpose of this studywas to determine the effect of a combination of the technique marmet andwarm compresses on milk production. The study was conducted in August2019 until April 2020 in PMB Dince Safrina City of Pekanbaru. This typeof research is quantitative research using a Quasi Experiment design. Thepopulation in this study were all postpartum mothers in January-February2020 who delivered at PMB Dince Safrina totaling 27 people. Thesample in this study were 20 postpartum mothers taken with incidentalsampling technique. Data collection uses the observation method using anobservation sheet. Data analysis used independent t test with asignificance level of 95%. The results showed that the average milkproduction in the combination intervention group was 107.00 ml (SD22.63) compared to the marmet technical intervention group which was77.00 ml (SD 27.10). The conclusion of the study is the influence of thetechnique of marmet with and without warm compresses on milkproduction in postpartum mothers (p = 0, 015), it intended thecombination of marmet technique and warm compresses is more effectivein increasing milk production. The advice given is that a combination of themarmet technique and warm compresses can be applied in midwiferycare for postpartum mothers to help increase and expedite milkproduction.

Association between maternal satisfaction with breastfeeding and postpartum depression symptoms

Background Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth. Methods This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) and negative PPD screening test was assessed using Poisson regression with robust variance, adjusting for specific covariables. Adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated. Results The prevalence of increased satisfaction with breastfeeding (defined as women with scores above the median) was 47% higher among women who screened negative for PPD when compared to those with a positive result (aPR 1.47; 95%CI 1.01–2.16). This result was adjusted for maternal age and skin color, cohabitation with the infant’s father, planned pregnancy, type of delivery, exclusive breastfeeding, and occurrence of breastfeeding problems. Conclusions The findings of this study showed an association between higher maternal satisfaction with breastfeeding and absence of PPD symptoms, reinforcing the importance of caring for the mental health of pregnant and puerperal women and paying attention to their satisfaction with breastfeeding.

Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge

Background Pathologic nipple discharge (PND) is a common complaint often associated with breast cancer. However, when ultrasound and mammography are negative, the chances of malignancy are lower than 5%. Currently, major duct excision and microdochectomy are often recommended to alleviate symptoms and definitely rule out malignancy, but can cause infections and breastfeeding problems. Ductoscopy is a minimally invasive endoscopy technique that allows visualization of the mammary ducts and may not only obviate surgery but also detect malignancy. The aim of this study was to determine quality of life (QOL) after ductoscopy in patients with PND. Materials and methods All PND patients referred for ductoscopy between 2014 and 2015 to our hospital were included. Ductoscopy procedures were performed under local anaesthesia in the outpatient clinic. Patients were asked to fill out questionnaires (Breast-Q, EQ-5D-5L and SF-36) on the day of ductoscopy, and after 2 weeks, 3 and 6 months. Additionally, we performed reliability analysis to determine if these questionnaires were suitable for PND patients. Results Fifty consecutive patients underwent ductoscopy of whom 47 patients participated in this study. One domain of SF-36 (vitality) varied significantly over time. Breast-Q, SF-36 and EQ-5D-5L showed that QOL after ductoscopy for PND was unaffected by ductoscopy. Success of the ductoscopy procedure was a significant predictor for satisfaction with the result domain. Conclusion Ductoscopy is a minimally invasive technique that does not seem to impact QoL of PND patients over time. Breast-Q, SF-36 and EQ-5D-5L seem to be suitable existing QOL tests for PND patients undergoing ductoscopy, whereas SF-36 would require modifications.