A randomised controlled trial evaluating the effect of a brief motivational intervention to promote breastfeeding in postpartum depression

Postpartum depression (PPD) is the most frequent psychiatric complication during the postnatal period. According to existing evidence, an association exists between the development of PPD and the maintenance of breastfeeding. A brief motivational intervention (bMI), based on the motivational interview, seems effective in promoting breastfeeding. The objective of this study was to analyse the impact of a bMI aiming to promote breastfeeding on the development of PPD and explore the mediating/moderating roles of breastfeeding and breastfeeding self-efficacy in the effect of the intervention on developing PPD. Eighty-eight women who gave birth by vaginal delivery and started breastfeeding during the immediate postpartum period were randomly assigned to the intervention group (bMI) or control group (breastfeeding education). Randomisation by minimisation was carried out. The breastfeeding duration was longer in the intervention group (11.06 (± 2.94) weeks vs 9.02 (± 4.44), p = 0.013). The bMI was associated with a lower score on the Edinburgh Postnatal Depression Scale, with a regression β coefficient of − 2.12 (95% CI − 3.82; − 0.41). A part of this effect was mediated by the effect of the intervention on the duration of breastfeeding (mediation/moderation index β = − 0.57 (95% CI − 1.30; − 0.04)). These findings suggest that a bMI aiming to promote breastfeeding has a positive impact preventing PPD mainly due to its effectiveness in increasing the duration of breastfeeding.

Breastfeeding, rapid growth in the first year of life and excess weight at age 2 years: the 3D Cohort Study

Objective: To assess relationships between breastfeeding, rapid growth in the first year of life, and overweight/obesity status at age 2. Design: As part of an observational, longitudinal study beginning in early pregnancy, multivariable logistic regressions were used to assess associations between breastfeeding duration (total and exclusive) and rapid weight gain (RWG) between birth and age 1, and to determine predictors of overweight/obesity status at age 2. Setting: 9 hospitals located in the province of Quebec, Canada. Participants: 1599 term infants participating in the 3D Cohort Study Results: Children having RWG in the first year and those having excess weight at age 2 accounted for 28% and <10%, respectively. In multivariable models, children breastfed <6 months and from 6 months to <1 year were, respectively, 2.5 times (OR: 2.45; 95% CI: 1.76-3.41) and 1.8 times (OR: 1.78; 1.29-2.45) more likely to show RWG up to age 1 compared to children breastfed ≥ 1 year. Children exclusively breastfed < 3 months had significantly greater odds of RWG in the first year (OR: 1.94; 1.25-3.04) compared to children exclusively breastfed for ≥6 months. Associations between breastfeeding duration (total or exclusive) and excess weight at age 2 were not detected. RWG in the first year was found to be the main predictor of excess weight at age 2 (OR: 6.98; 4.35-11.47). Conclusions: The potential beneficial effects of breastfeeding on rate of growth in the first year of life suggest that interventions promoting breastfeeding are relevant for obesity prevention early in life.

Impact of telelactation services on breastfeeding outcomes among Black and Latinx parents: protocol for the Tele-MILC randomized controlled trial

Background Breastfeeding offers many medical and neurodevelopmental advantages for birthing parents and infants; however, the majority of parents stop breastfeeding before it is recommended. Professional lactation support by the International Board Certified Lactation Consultants (IBCLCs) increases breastfeeding rates; however, many communities lack access to IBCLCs. Black and Latinx parents have lower breastfeeding rates, and limited access to professional lactation support may contribute to this disparity. Virtual “telelactation” consults that use two-way video have the potential to increase access to IBCLCs among disadvantaged populations. We present a protocol for the digital Tele-MILC trial, which uses mixed methods to evaluate the impact of telelactation services on breastfeeding outcomes. The objective of this pragmatic, parallel design randomized controlled trial is to assess the impact of telelactation on breastfeeding duration and exclusivity and explore how acceptability of and experiences with telelactation vary across Latinx, Black, and non-Black and non-Latinx parents to guide future improvement of these services. Methods 2400 primiparous, pregnant individuals age > 18 who intend to breastfeed and live in the USA underserved by IBCLCs will be recruited. Recruitment will occur via Ovia, a pregnancy tracker mobile phone application (app) used by over one million pregnant individuals in the USA annually. Participants will be randomized to (1) on-demand telelactation video calls on personal devices or (2) ebook on infant care/usual care. Breastfeeding outcomes will be captured via surveys and interviews and compared across racial and ethnic groups. This study will track participants for 8 months (including 6 months postpartum). Primary outcomes include breastfeeding duration and breastfeeding exclusivity. We will quantify differences in these outcomes across racial and ethnic groups. Both intention-to-treat and as-treated (using instrumental variable methods) analyses will be performed. This study will also generate qualitative data on the experiences of different subgroups of parents with the telelactation intervention, including barriers to use, satisfaction, and strengths and limitations of this delivery model. Discussion This is the first randomized study evaluating the impact of telelactation on breastfeeding outcomes. It will inform the design and implementation of future digital trials among pregnant and postpartum people, including Black and Latinx populations which are historically underrepresented in clinical trials. Trial registration ClinicalTrials.gov NCT04856163. Registered on April 23, 2021

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 Duration and Its Effective Factors in Mothers with Children Aged 30-36 Months in Kerman in 2020

Introduction: Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers' ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors.Methods: This study was a descriptive-analytical and cross-sectional type. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach's alpha of 85%. Data were analyzed using SPSS software version 16.Results: The mean time of breastfeeding was 19.23±7.09 and the median was 22-month-year. About 41% of children were breastfed until 24-month-year. There was a significant relationship between the time of cessation of breastfeeding with contraception, number of households, place of residence, and weight at 6-month-year at the level of 0.05.Conclusion: Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB differs from the suggestions of the World Health Organization (WHO) and religious teachings. Useful interventions are needed to increase the duration of breastfeeding.

Association of Voluntary Legal Paternity and Breastfeeding Duration and Exclusivity in a Sample of Mothers in NewYork State, United States

Background and Objective: Globally, father engagement is deemed an important factor in mothers’ breastfeeding practices. In the U.S., the role of the father in breastfeeding is understudied. This study examines the association between voluntary legal paternity and maternal breastfeeding outcomes. Methods: Using data from a modified Pregnancy Risk Assessment Monitoring System survey (Monroe County, NY, 2015-2017) linked to New York State’s birth certificate data, we assessed breastfeeding outcomes (exclusivity and duration) by voluntary legal paternity (VLP) establishment. We examined breastfeeding duration (breastfeeding cessation at 13 weeks or less) and exclusive breastfeeding (at 13 weeks) among mothers whose infants had VLP (i.e., married, acknowledgment at birth), and those who had no-VLP (i.e., a court-mandated Paternity Affidavit or no legal paternity established). Univariate analyses were conducted, with additional variables (parental demographics, maternal social and clinical) included subsequently. The backward elimination method was used to determine the set of covariates to adjust in the model. Results: Of the 1,753 mothers initiating breastfeeding, 1,364 had VLP and 389 had no-VLP established. Mothers of infants with a no-VLP were more likely to be Black (29.49%), Hispanic (17.74%), have lower income (80.21%), have lower-education levels (44.73%) and were more likely to be <30 years old (61.7%), and had higher levels (14.4%) of reported traumatic stress before and during the most recent pregnancy. Among mothers initiating breastfeeding, those with no-VLP had a higher risk of breastfeeding cessation at 13 weeks (OR: 2.06; 95% CI, 1.25-3.42) after adjusting for maternal resilience, social support, hospital breastfeeding support, pre-pregnancy BMI, paternal age, and paternal education; and higher risk of breastfeeding cessation at 13 weeks (OR:1.46; 1.01-2.09). Conclusion and Implications for Translation: Voluntary legal establishment of paternity is associated with maternal breastfeeding outcomes. Screening of mothers may include legal paternity status as a further indication of the need for additional breastfeeding support, especially among socio-economically disadvantaged populations. Copyright © 2021 Alio et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Factors associated with breastfeeding initiation and continuation in Canadian-born and non-Canadian-born women: a multi-centre study

Objective: To identify factors associated with breastfeeding initiation and continuation in Canadian-born and non-Canadian-born women. Design: Prospective cohort of mothers and infants born from 2008–2012: the CHILD Cohort Study. Setting: General community setting in four Canadian provinces. Participants: 3455 pregnant women from Vancouver, Edmonton, Winnipeg, and Toronto between 2008 and 2012. Results: Of 3010 participants included in this study, the majority were Canadian-born (75.5%). Breastfeeding initiation rates were high in both non-Canadian-born (95.5%) and Canadian-born participants (92.7%). The median breastfeeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breastfeeding initiation and continuation were older maternal age, higher maternal education, living with their partner, and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breastfeeding initiation, but not continuation at 6-months postpartum. Factors associated with non-initiation of breastfeeding and cessation at 6-months postpartum were maternal smoking, living with a current smoker, cesarean birth, and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breastfeeding initiation, and lower odds of breastfeeding continuation at 6 months, and older maternal age and recruitment site were associated with breastfeeding continuation at 6 months. Conclusions: Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breastfeeding initiation rates, breastfeeding initiation and continuation are more strongly associated with sociodemographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breastfeeding continuation in both groups and may indicate geographic disparities in breastfeeding rates nationally.

Effects of Cognitive Nursing Combined with Continuous Nursing on Postpartum Mental State and Rehabilitation

Purpose. This study is aimed at exploring the effects of cognitive nursing combined with continuous nursing on postpartum mental state and rehabilitation. Methods. Totally, 124 puerperas admitted to our hospital from January 2019 to January 2020 were selected and divided into a research group and a control group according to different nursing methods, with 62 cases in each group. The control group received routine care, while the research group received cognitive nursing combined with continuous nursing on this basis. The mental state, rehabilitation indicators, quality of life, incidence of complications, and nursing satisfaction were compared between the two groups after intervention. Results. Before nursing, there was no statistically significant difference in the SAS and SDS scores between the two groups ( P > 0.05 ); after intervention, the SAS and SDS scores of the two groups were significantly reduced, and those of the research group were lower than those of the control group ( P < 0.05 ). After intervention, the time of the first breastfeeding, duration of lochia rubra, length of hospital stay, and score of uterine contraction pain of the research group were lower than those of the control group ( P < 0.05 ); the psychological function, physical function, material life, and social function scores of the research group were higher than those of the control group ( P < 0.05 ); the incidence of complications in the research group was 4.84%, lower than 20.97% in the control group ( P < 0.05 ); the nursing satisfaction of the research group was 96.77%, which was significantly higher than 83.87% in the control group ( P < 0.05 ). Conclusions. Cognitive nursing combined with continuous nursing can effectively improve the mental state, shorten the length of hospital stay, increase the perceived well-being, and promote the physical rehabilitation in puerperas, which is worth promoting in clinical practice.