Breastfeeding,
how...
Cochrane
reviews
Deshpande
AD, Gazmararian JA. Breastfeeding education and support:
association with the decision to breastfeed. Eff
Clin Pract 2000;3:116-22.
Deshpande
AD, Gazmararian JA. Breastfeeding education and support:
association with the decision to breastfeed. Eff Clin
Pract 2000;3:116-22 To identify factors associated with
the initiation and duration of breastfeeding in managed
care enrollees who had had a normal vaginal delivery,
a telephone survey of 5,213 new mothers (4 to 6 months
postpartum) was conducted (response rate 72%). 75% of
respondents reported ever breastfeeding, and of those
women, 75% reported breastfeeding for more than 6 weeks.
In adjusted multivariate analyses, breastfeeding was
affected by education, employment, and marital status.
Women who were more likely to breastfeed were those
who attended childbirth classes, those who received
prenatal breastfeeding advice, and those who received
postpartum breastfeeding assistance. Breastfeeding for
more than 6 weeks postpartum was associated with education,
employment status, and the adequacy of postpartum information.
These findings suggest that in the USA health plans
and employees may promote breastfeeding by providing
breastfeeding education and support.
Abada
TS, Trovato F, Lalu N. Determinants of breastfeeding
in the Philippines: a survival analysis. Soc
Sci Med 2001;52:71-81
This study
examines modern and traditional factors that may lengthen
or shorten the duration of breastfeeding. Specifically,
health sector, socio economic, demographic, and supplementary
food variables are analysed among a large representative
sample of women in the Philippines. The results show
that traditional factors associated with breastfeeding
(use of solid foods such as porridge and applesauce,
and prenatal care by a traditional nurse/midwife) do
not play a significant role in the mother's decision
to continue breastfeeding. Factors associated with modernity
are significant in explaining early termination of breastfeeding
(respondent's education, prenatal care by a medical
doctor, delivery in a hospital, and use of infant formula).
The findings
of this study suggest that health institutions and medical
professionals can play a significant role in promoting
breastfeeding in the Philippines; and educational campaigns
that stress the benefits of lactation are important
strategies for encouraging mothers to breastfeed longer.
Arora
S, McJunkin C, Wehrer J, Kuhn P. Major factors influencing
breastfeeding rates: Mother's perception of father's
attitude and milk supply. Pediatrics 2000;106:E67
To determine
factors influencing feeding decisions, breastfeeding
and/or bottle initiation rates, as well as breastfeeding
duration, a mail survey was carried out in 245 mothers
whose infants received well-child care from birth to
1 year of age in a family medicine practice of a 530-bed
community-based hospital in northwestern Pennsylvania.
The breastfeeding initiation rate was 44.3%. By the
time the infant was 6 months old, only 13% of these
were still breastfeeding. The decision to breastfeed
or to bottle-feed was most often made before pregnancy
or during the first trimester of pregnancy. The most
common reasons mothers chose breastfeeding included:
- benefits
to the infant's health,
- naturalness,
and
- emotional
bonding with the infant.
The most
common reasons bottle-feeding was chosen included:
- mother's
perception of father's attitude,
- uncertainty
regarding the quantity of breast milk, and
- return
to work.
By self-report,
factors that would have encouraged bottle-feeding mothers
to breastfeed included:
- more
information in prenatal classes;
- more
information from TV, magazines, and books; and
- family
support.
To overcome
obstacles, issues surrounding perceived barriers, such
as father's attitude, quantity of milk, and time constraints,
need to be discussed with each parent.
Hannon
PR, Willis SK, Bishop-Townsend V, Martinez IM, Scrimshaw
SC. African-American and Latina adolescent mothers'
infant feeding decisions and breastfeeding practices:
a qualitative study. J Adolesc Health 2000;26:399-407
To explore
minority teen mothers' perceptions of breastfeeding
and the influences on infant feeding choices, a qualitative
study using semistructured ethnographic interviews and
focus groups was conducted with 35 Latina and African-American
girls in Chicago between the ages of 12 and 19 years
who were primiparous and were currently pregnant or
had delivered within the past 3 months. Adolescents
identified three main influences on infant feeding decisions
and practices:
- their
perceptions of the benefits of breastfeeding,
- their
perceptions of the problems with breastfeeding, and
- influential
people.
In this study,
teens reported no single influence which determined
infant feeding choices. The decision to breastfeed was
a dynamic process. Teens recognized that breastfeeding
offered many benefits including facilitating maternal-child
bonding and promoting the baby's health, but concern
was raised regarding a potential for excessive attachment
between teen mother and baby. Fear of pain, embarrassment
with public exposure, and unease with the act of breastfeeding
acted as barriers for teenagers who were considering
breastfeeding. The adolescents' mothers continued to
be an important influence.
The ranges
of perceptions and influences that minority adolescent
mothers have identified as affecting their infant feeding
choices, illustrated and explained in the teens' own
words, are helpful to health care providers as they
counsel teen mothers about infant feeding options.
Donath
SM, Amir LH. Does maternal obesity adversely affect
breastfeeding initiation and duration? J Paediatr
Child Health 2000;36:482-6
To examine
the relationship between maternal obesity and the initiation
and duration of breastfeeding, an analysis was made
of the 1995 National Health Survey, in which personal
interviews were conducted on a sample of private dwellings
and a list sample of non-private dwellings in all States
and Territories of Australia. Mothers between the ages
of 17 and 50 years (n=1991) with children under the
age of 4 years in 1995 participated in the study. Of
the group of mothers with a body mass index (BMI) of
20-25, 89.2% initiated breastfeeding, compared with
82.3% of mothers with a BMI of 30 or more. There was
also a significant difference between the mean and median
duration of breastfeeding of obese and non-obese mothers.
These differences remained significant when maternal
smoking, age and other sociodemographic factors were
taken into consideration. Health professionals should
be aware that obese women may be at increased risk of
not breastfeeding or stopping breastfeeding prematurely.
Volpe
EM, Bear M. Enhancing breastfeeding initiation in
adolescent mothers through the Breastfeeding Educated
and Supported Teen (BEST) Club. J Hum Lact 2000;16:196-200
The purpose
of this study was to determine if specific breastfeeding
education, provided by a lactation consultant in group
classes for pregnant adolescents, would increase breastfeeding
initiation among students enrolled in a high school
adolescent pregnancy program. 91 pregnant adolescents
participated in the study and were divided into two
groups: those who did not receive specific breastfeeding
education and those who did. There were no significant
differences in breastfeeding initiation with regard
to age or ethnicity. Of the 48 adolescents who received
no specific education, 7 (14.6%) initiated breastfeeding.
Of the 43 adolescents in the education group, 28 (65.1%)
initiated breastfeeding, which indicates a significant
difference between groups with regard to infant feeding
choice.
The results
of this study indicate that targeted educational programmes
designed for the adolescent learner may be successful
in improving breastfeeding initiation in this population.
Lu
MC, Lange L, Slusser W, Hamilton J, Halfon N. Provider
encouragement of breastfeeding: evidence from a national
survey. Obstet Gynecol 2001;97:290-5
To examine
the influence of provider encouragement on breastfeeding
among women of different social and ethnic backgrounds
in the United States, a nationally repres-entative sample
of 2,017 parents with children younger than 3 years
was surveyed by telephone. The responses of the 1,229
women interviewed were included in the analysis. Respondents
were asked to recall whether their physicians or nurses
had encouraged or discouraged them from breastfeeding.
34.4% of respondents did not initiate breastfeeding.
73.2% of women reported having been encouraged by their
physicians or nurses to breastfeed; 74.6% of women who
were encouraged initiated breastfeeding, compared with
only 43.2% of those who were not encouraged. Women who
were encouraged to breastfeed were more than 4 times
as likely to initiate breastfeeding as women who did
not receive encourage-ment. The influence of provider
encouragement was significant across all strata of the
sample. In populations traditionally less likely to
breastfeed, provider encouragement significantly increased
breastfeeding initiation, by more than 3-fold among
low-income, young, and less-educated women; by nearly
5-fold among black women; and by nearly 11-fold among
single women.
Sheehan
A. A comparison of two methods of antenatal breastfeeding
education. Midwifery 1999;15:274-82
The objective
of this study was to compare a woman-centered antenatal
breastfeeding programme based on con-cepts of peer and
husband/partner support with a control group, who received
antenatal breastfeeding education led by a midwife childbirth
educator. In a large private hospital in Sydney, Australia,
154 highly educated primiparous women who attended childbirth
classes were assigned to the control group (n=86) or
to the experimental group (n=68) in which representatives
of the Nursing Mothers Association of Australia, their
male partners and a mother who was willing to demonstrate
breastfeeding provided the intervention. No differences
were found between groups in relation to maternal perceptions
of success or duration of breastfeeding, which was overall
very high when compared to previously reported breastfeeding
duration rates in Australia.
This research
found that a peer-led model of breastfeeding education
was as effective as a midwife-led group in producing
breastfeeding initiation and duration rates higher than
others previously reported, with the potential to enhance
social support networks.
McCarthy
JJ, Posey BL. Methadone levels in human milk.
J Hum Lact 2000;16:115-20
Pregnant
women on methadone maintenance therapy frequently want
to nurse yet are often discouraged from doing so because
of concern about the amount of methadone that may be
in the breastmilk. This study analyzed the levels of
methadone in the milk of nursing mothers and compared
these levels to those in other published reports. 14
breastmilk samples were obtained from 8 women maintained
on methadone doses of 25 to 180 mg/day. Methadone levels
in milk ranged from 27 to 260 ng/ml, with a mean level
for the group of 95 ng/ml. The mean daily methadone
ingestion, based on a newborn intake of 475 ml/day of
breastmilk, was 0.05 mg/day. This level is small and
consistent with those in other published reports. Breastfeeding
duration ranged from 2.5 to 21 months. There were no
adverse effects associated with breastfeeding or weaning.
This study
supports the compatibility of breastfeeding and methadone
maintenance therapy.
Riordan
J, Gross A, Angeron J, Krumwiede B, Melin J. The
effect of labor pain relief medication on neonatal suckling
and breastfeeding duration. J Hum Lact 2000;16:7-12
The relationship
of labour pain relief medications with neonatal suckling
and breastfeeding duration was examined in 129 mothers
delivering vaginally. Suckling scores for intravenous
and epidural groups were similar while those who received
a combination of both intravenous and epidural medications
were lower. Breastfeeding duration did not differ between
unmedicated and medicated groups; however, dyads with
low suckling scores weaned earlier than those with medium
or high scores. Labour pain relief medications diminish
early suckling but are not associated with duration
of breastfeeding through 6 weeks postpartum.
Hoseth
E, Joergensen A, Ebbesen F, Moeller M. Blood glucose
levels in a population of healthy, breast fed, term
infants of appropriate size for gestational age.
Arch Dis Child Fetal Neonatal Ed 2000;83:F117-9
The blood
glucose concentration of 223 healthy, breastfed, term
infants of appropriate size for gestational age was
determined at different times (between one and 96 hours)
after delivery. One sample of blood glucose was taken
from each infant independent of the feeding time. Infants
suspected of suffering from intrapartum hypoxia were
excluded. Blood glucose concentration one hour after
delivery was not significantly lower than at any other
time. Only two infants had low blood glucose concentrations
one hour after delivery (1.4 and 1.9 mmol/l). There
were no significant differences in blood glucose concentration
between sexes, methods of delivery, infants delivered
with or without analgesia, and infants born to smokers
or non-smokers, and there was no further correlation
between blood glucose concentration and gestational
age, umbilical cord pH, or Apgar score.
The authors
conclude that very few healthy, breastfed, term infants
of appropriate size for gestational age have low blood
glucose levels, and there is no indication for blood
glucose monitoring in these infants.
Meier
PP, Brown LP, Hurst NM, Spatz DL, Engstrom JL, Borucki
LC, Krouse AM. Nipple shields for preterm infants:
effect on milk transfer and duration of breastfeeding.
J Hum Lact 2000;16:106-14
This study
reports breastfeeding outcomes for 34 preterm infants
whose mothers used ultrathin silicone nipple shields
to increase milk transfer. Mean milk transfer was compared
for two consecutive breastfeedings with and without
the nipple shield. Total duration of breastfeeding was
calculated for a maximum of 365 days. Mean milk transfer
was significantly greater for feedings with the nipple
shield (18.4 ml vs. 3.9 ml), with all 34 infants consuming
more milk with the nipple shield in place. Mean duration
of nipple shield use was 32.5 days, and mean duration
of breastfeeding was 169.4 days; no association between
these variables was noted. The nipple shield was used
for 24.3% of the total breastfeeding experience, with
no significant association between the percentage of
time the shield was used and total duration of breastfeeding.
These findings
are the first to indicate that nipple shield use increases
milk intake without decreasing total duration of breastfeeding
for preterm infants.
Killersreiter
B, Grimmer I, Buhrer C, Dudenhausen JW, Obladen M. Early
cessation of breastmilk feeding in very low birthweight
infants. Early Hum Dev 2001;60:193-205
This investigation
was carried out to assess the duration of breastmilk
feeding and to analyze risk factors for early cessation
of breastmilk feeding in term and very preterm infants.
A cohort study was performed in 89 consecutive very
low birthweight (VLBW) infants (<1500 g) who survived
for at least one week, and 177 term infants with birthweights
>2500 g born in the same hospital matched for gender
and multiplicity. Median duration of breastmilk feeding,
as determined from charts and questionnaires mailed
to the mothers at 6 and 12 months corrected age, was
36 days in VLBW infants, compared to 112 days in control
infants. In both VLBW and control infants, smoking during
pregnancy, low maternal and paternal school education
were each significantly associated with short duration
of breastmilk feeding. In VLBW infants, multiple pregnancy
and gestational age <29 weeks were each associated with
prolonged breastmilk feeding, as were maternal age >35
years and spontaneous pregnancy (as opposed to pregnancy
following infertility treatment) in term infants. Multivariate
analysis revealed that VLBW, smoking and low parental
school education were independent negative predictors
of breastmilk feeding.
While these
results emphasize the need for special support of VLBW
infant mothers promoting lactation, the relationships
between smoking, school education and breastmilk feeding
in both strata show that efforts to increase breastmilk
feeding require a public health perspective.
Cohen
RJ, Brown KH, Rivera LL, Dewey KG. Exclusively breastfed,
low birthweight term infants do not need supplemental
water. Acta Paediatr 2000;89:550-2
Breastmilk
intake, urine volume and urine-specific gravity (USG)
of exclusively breastfed, low birthweight (LBW) term
male infants in Honduras were measured during 8-hour
periods at 2 (n=59) and 8 (n=68) weeks of age. Ambient
temperature was 22-36 C° and relative humidity was 37-86%.
Maximum USG ranged from 1.001 to 1.012, all within normal
limits. It is concluded that supplemental water is not
required for exclusively breastfed, LBW term infants,
even in hot conditions.
Almroth
S, Mohale M, Latham MC. Unnecessary water supplementation
for babies: grandmothers blame clinics. Acta
Paediatr 2000;89:1408-13
This study
was designed to obtain policy- and programme-relevant
data on exclusive breastfeeding in Lesotho. Qualitative
information was obtained through focus groups and individual
interviews with mothers, grandmothers and nurses. This
was complemented with quantitative data collected through
a clinic-based survey of mothers. The qualitative and
the quantitative findings consistently converged, illustrating
a culture of infant feeding in which breastfeeding was
central, but exclusive breastfeeding was an unknown
concept and not practised. Grandmothers seemed to be
more in tune with the ideal of exclusive breastfeeding
as they had given their young infants thin gruel only
occasionally. Contemporary mothers, in contrast, regularly
gave their young infants water. Mothers and grandmothers
frequently cited nurses as the source of advice for
giving water. Grandmothers were adamant in pointing
out that they had never given water to their own young
infants and asserted that they avoided giving it to
their grandchildren as they considered it unnecessary
and harmful. According to the grandmothers, water supplementation
was a new practice that had been introduced through
the clinics. Efforts to discourage water supplementation
and encourage exclusive breastfeeding in this setting
need to be directed both at mothers and health providers.
Margolis
LH, Schwartz JB. The relationship between the timing
of maternal postpartum hospital discharge and breastfeeding.
J Hum Lact 2000;16:121-8
This study
examines the association between discharge timing and
breastfeeding, controlling for demographic, economic,
and health factors that influence both. The results
demonstrate that mothers who spent 1 night in the hospital
were almost twice as likely to breastfeed than mothers
who spent 2 or 3 nights in the hospital. Instead of
basing discharge solely on predetermined rules, derived
largely from financial criteria, attention to the decision-making
process should be an important part of newborn discharge
policies.
Hall
RT, Simon S, Smith MT. Readmission of breastfed infants
in the first 2 weeks of life. J Perinatol 2000;20:432-7
The purpose
of the study was to look at factors associated with
readmission of breastfeeding infants for jaundice and/or
dehydration. The records of 125 breastfeeding infants
who were admitted to hospital from 1995 to 1997 in the
first 2 weeks of life with diagnoses of jaundice, dehydration,
or feeding problems were reviewed. Infants with hemolytic
disease, infection, or other underlying causes were
excluded.
This study
confirms that prematurity and short hospital stay (less
than 3 days) are risk factors for readmission of breastfeeding
infants with jaundice and/or dehydration.
Kramer
MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich
I, Shapiro S, Collet JP, Vanilovich I, Mezen I, Ducruet
T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy
V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova
L, Helsing E, for the PROBIT Study Group. Promotion
of Breastfeeding Intervention Trial (PROBIT): a randomized
trial in the Republic of Belarus. JAMA 2001;285:413-20
The objective
of this study was to assess the effects of breastfeeding
promotion on breastfeeding duration and exclusivity
and gastrointestinal and respiratory infection and atopic
eczema among infants. 31 maternity hospitals and polyclinics
in the Republic of Belarus were randomly assigned to
receive an experimental intervention (n=16) modeled
on the Baby-Friendly Hospital Initiative (BFHI) of the
WHO and UNICEF, which emphasizes health care worker
assistance with initiating and maintaining breastfeeding
and lactation and postnatal breastfeeding support, or
a control intervention (n=15) of continuing usual infant
feeding practices and policies. A total of 17,046 mother-infant
pairs consisting of full-term singleton infants weighing
at least 2500 g and their healthy mothers who intended
to breastfeed were followed-up for 12 months; 16,491
(96.7%) completed the entire follow-up. Infants from
the intervention sites were significantly more likely
than control infants to be breastfed to any degree at
12 months (19.7% vs 11.4%), were more likely to be exclusively
breastfed at 3 months (43.3% vs 6.4%) and at 6 months
(7.9% vs 0.6%), and had a significant reduction in the
risk of one or more gastrointestinal tract infections
(9.1% vs 13.2%) and of atopic eczema (3.3% vs 6.3%),
but no significant reduction in respiratory tract infection.
Implementation of the BFHI increases the duration and
degree (exclusivity) of breastfeeding and decreases
the risk of gastrointestinal tract infection and atopic
eczema in the first year of life.
These results
provide a solid scientific underpinning for future interventions
to promote breastfeeding.
Shariff
F, Levitt C, Kaczorowski J, Wakefield J, Dawson H, Sheehan
D, Sellors J. Workshop to implement the baby-friendly
office initiative. Effect on community physicians' offices.
Can Fam Physician 2000;46:1090-7
To assess
the effect of a self-appraisal questionnaire and a workshop
for office staff in promoting the "10 Steps to Baby-Friendly
Office" in Canada, an early intervention group of primary
care pediatricians attended the workshop in October
1997 (n=23) and a late-intervention group in April 1998
(n=23). Self-appraisals were completed before the workshops
by all participants in October 1997, by 37 offices in
April 1998, and by 34 offices in October 1998. Of the
34 offices completing all assessments, none followed
all 10 steps. Initial mean score was 4.4 steps. The
workshop intervention improved overall mean scores from
4.3 to 5.6. The self-appraisal tool alone had no effect
on scores. Areas of improvement were noted in providing
information to patients and displaying posters to promote
breastfeeding. Key steps, such as not advertising breastmilk
substitutes and not distributing free formula, did not
change. The workshop effected a modest but positive
change in breastfeeding promotion. The change was maintained
at 6 and 12 months after the intervention.
Porteous
R, Kaufman K, Rush J. The effect of individualized
professional support on duration of breastfeeding: a
randomized controlled trial. J Hum Lact 2000;16:303-8
A trial was
conducted with 51 women randomly assigned either to
a conventional nursing care group or to an individualized
professional support group to examine the effect of
professional support on breastfeeding status at 4 weeks
postpartum. All participants identified themselves as
having no prior support. At 4 weeks postpartum, 17 out
of 25 (68%) and 26 out of 26 (100%) women in the control
and intervention groups, respectively, continued to
breastfeed. Results indicate that postpartum care augmented
with individualized professional support commenced in
the hospital and continued in the community, significantly
increases the duration of breastfeeding among women
who identify themselves as being without support for
the first month postpartum.
Hoddinott
P, Pill R, Hood K. Identifying which women will stop
breastfeeding before three months in primary care: a
pragmatic study. Br J Gen Pract 2000;50:888-91
In Britain
only 42% of women who initiate breastfeeding are still
breastfeeding at four months, despite well documented
health benefits. To explore whether sociodemographic
and social support information collected routinely by
health visitors at the new birth assessment can help
predict which women will give up breastfeeding before
three months, a survey of 279 consecutive births in
three general practices was carried out in an inner-London
borough. Health visitors collected sociodemographic,
infant feeding, and social support data at the new birth
assessment 10 to 14 days after birth and at an immunisation
visit at three to four months after birth. Three variables
were found to be significantly associated with breastfeeding
at three months. Younger women and women with moderate
to poor emotional support as assessed by their health
visitor were less likely to still be breastfeeding at
three months. White women who left full-time education
at age 16 years or below were least likely to be breastfeeding
at three months but educational level was not a significant
predictor for women from other ethnic backgrounds.
This pragmatic
study illustrates how information collected during routine
clinical care by health visitors can help predict which
women will give up breastfeeding before three months.
This could be useful to identify women whose social
support needs are not being met and who may benefit
from local initiatives.
McInnes
RJ, Love JG, Stone DH. Evaluation of a community-based
intervention to increase breastfeeding prevalence.
J Public Health Med 2000;22:138-45
The aim of
the study was to determine whether peer counselling
in the antenatal and post-natal period would increase
the prevalence and duration of breastfeeding among low-income
women in Glasgow. The intervention comprised peer counselling
of pregnant women, support of breastfeeding mothers
and local awareness-raising activities. The study subjects
were all women attending the antenatal booking clinic
resident in either the intervention or control area.
Of the 995 women enrolled in the study, data were available
for analysis on 919 (92%) to 6 weeks postnatally. At
booking, 18% of the intervention group and 21% of the
control group stated an intention to breastfeed. At
delivery, the proportions initiating breastfeeding were
23% of the intervention subjects and 20% of the controls,
and by 6 weeks post-natally, the proportion providing
any breastmilk had declined to 10% of the intervention
group and 8% of the control group. The breastfeeding
prevalence was twice as high in the intervention group
relative to the controls at delivery; by 6 weeks post-natally
the difference between the two groups was not statistically
significant. As the impact of the intervention was not
sustained even for the modest duration of 6 weeks postnatally,
it would be premature to justify widespread use of peer
support programmes to increase the prevalence of breastfeeding
in socially disadvantaged communities.
Ladzani
R, Steyn NP, Nel JH. An evaluation of the effectiveness
of nutrition advisers in three rural areas of northern
province. S Afr Med J 2000;90:811-6
To evaluate
the efficacy of a nutrition education intervention programme
undertaken by trained local women (nutrition advisors)
in rural villages in South Africa, a cross-sectional
survey was undertaken in 1989 and again in 1992. Six
trained nutrition advisors delivered nutrition education
to female caregivers of infants in three study villages,
but not in three control villages, between the surveys.
Households were randomly selected. The response rate
of households was 70% (n=1040) at baseline and 84% (n=1263)
after intervention. The percentage of women who initiated
breastfeeding on the day of birth improved significantly
in the study area from 60% to 90%. The frequency of
feeding infants at 6 months improved too. The introduction
of solid foods to infants on the first day of life decreased
from 26.5% to 6.3% in the study area. A nutrition education
programme undertaken by trained local women can significantly
improve breastfeeding and infant feeding practices in
rural areas.
Valdes
V, Pugin E, Schooley J, Catalan S, Aravena R. Clinical
support can make the difference in exclusive breastfeeding
success among working women. J Trop Pediatr 2000;46:149-54
Exclusive
breastfeeding has generally been considered incompatible
with working separated from the infant. This prospective,
controlled intervention trial conducted in Chile shows
that breastfeeding support, including anticipatory counselling
and monthly clinical follow-up of the mother and infant,
can significantly increase the percentage of infants
exclusively fed with breastmilk at the end of 6 months
of life. Over 80% of women from control and intervention
groups expressed a desire to breastfeed for more than
6 months and more than 50% thought it was best for the
infant to be exclusively breastfed for 6 months. Only
6% of women in the control group were able to complete
6 months of exclusive breastfeeding compared to 53%
of those in the intervention group. The most important
difference between the strategies used by both groups
of mothers for maintaining exclusive breastfeeding after
returning to work was that only 23% of the control group
practiced milk expression compared to 66% in the intervention
group. All women from the supported group stated that
they would advise a friend to combine exclusive breastfeeding
and work and that they would like to do so again with
another child.
Horta
BL, Kramer MS, Platt RW. Maternal smoking and the
risk of early weaning: a meta-analysis. Am J
Public Health 2001;91:304-7
This study
reviewed evidence on the effect of maternal smoking
on early weaning. Analysis was restricted to studies
in which infants who had never been breastfed were excluded
or the prevalence of breastfeeding initiation was more
than 90%. The risk for weaning before 3 months was almost
100% higher in smoking than in nonsmoking mothers. A
50% higher adjusted risk was shown in studies that had
lost-to-follow-up rates below 15% and included adequate
adjustment for confounding.
This review
confirms that maternal smoking increases the risk of
early weaning.
Hamprecht
K, Maschmann J, Vochem M, Dietz K, Speer CP, Jahn G.
Epidemiology of transmission of cytomegalovirus from
mother to preterm infant by breastfeeding. Lancet
2001;357:513-8
151 mothers
and their 176 preterm infants (gestational age at birth
<32 weeks or birthweight <1500 g) were prospectively
screened for cytomegalovirus infection by serology,
virus culture, and PCR. Of the 69 seronegative breastfeeding
control mothers, none had detectable cytomegalovirus
DNA in breastmilk and none of their 80 infants shed
the virus in urine. The proportion of cytomegalovirus
reactivation in seropositive breastfeeding mothers was
96% (73 of 76). The cumulative rate of transmission
was 37% (27 of 73 mothers; 33 infants). The infection
of the neonates had a mean incubation time of 42 days.
About 50% of the infected infants had no symptoms, but
four had sepsis-like symptoms. This study shows that
breastfeeding as a source of postnatal cytomegalovirus
infection in preterm infants has been underestimated
and may be associated with a symptomatic infection.
Measures, such as milk pasteurization, should be taken
to inactivate the virus in breastmilk from seropositive
mothers given to preterm infants.
Jeffery
BS, Mercer KG. Pretoria pasteurisation: a potential
method for the reduction of postnatal mother to child
transmission of the human immunodeficiency virus.
J Trop Pediatr 2000;46:219-23
HIV can be
transmitted by breastfeeding. The virus is inactivated
by heating. A simple and inexpensive method has been
devised by which expressed breastmilk may be pasteurised
in a domestic setting. The method uses the principle
of heat transfer from 450 ml of water heated to boiling
point in an aluminum pot to a smaller volume of milk
in a glass jar placed into the water. The method was
tested using differing starting values for volume of
milk (between 50 and 150 ml); initial temperature of
milk (between 37 C° and the ambient temperature); and
ambient temperature. Each of the parameters was varied
within the range indicated while all other conditions
were kept constant. Milk temperature remained between
56 and 62.5 C°, the ideal range, for a period ranging
from 10 to 15 minutes depending on the combination of
variables. The peak temperature and duration of time
in the ideal temperature range was minimally sensitive
to volume of milk, starting temperature of milk, and
ambient temperature. This method of pasteurisation is
feasible and reliable under a range of conditions, but
it requires refinement and further testing under different
conditions.
Aarts
C, Kylberg E, Hornell A, Hofvander Y, Gebre-Medhin M,
Greiner T. How exclusive is exclusive breastfeeding?
A comparison of data since birth with current status
data. Int J Epidemiol 2000;29:1041-6
There is
no accepted and widely used indicator for exclusive
breastfeeding since birth. Indeed, the difference between
"current status" data on exclusive breastfeeding and
data on "exclusive breastfeeding since birth" is rarely
recognized. The authors of this paper used data from
a longitudinal study on 506 mother-infant pairs in Sweden
to examine this issue. The mothers completed daily recordings
on infant feeding during the first 9 months after birth.
A research assistant conducted fortnightly home visits
with structured interviews. The results show a wide
discrepancy between the data obtained from the two sources.
The difference in the exclusive breastfeeding rate was
92% vs 51% at 2 months, 73% vs 30% at 4 months, and
11% vs 1.8% at 6 months. Current status indicators based
on a 24-hour period may be inadequate and even misleading
for many purposes.
Cochrane
reviews
Renfrew
MJ, Lang S, Woolridge MW. Early versus delayed initiation
of breastfeeding. Cochrane Database Syst Rev
2000;(2):CD000043
It has been
suggested that the timing of a baby's first breastfeed
may influence breastfeeding duration and emotional attachment.
The objective of this review was to assess the effects
of breastfeeding soon after birth (within 30 minutes)
compared to being breastfed later (between 4 to 8 hours
after delivery) on the duration of breastfeeding and
the mother/infant relationship. Three controlled studies
involving 209 women were included. Compared with late
contact and breastfeeding, early contact and breastfeeding
was associated with greater communication between mother
and infants in a two-minute observation period (or 0.14,
95% CI 0.03 to 0.61). There was no difference detected
for numbers of women breastfeeding after birth (OR for
12 weeks after birth 0.73, 95% CI 0.34 to 1.54).
The reviewers
found no differences between early and delayed contact
in regard to breastfeeding duration. Early contact was
associated with greater communication between mothers
and infants.
Renfrew
MJ, Lang S, Martin L, Woolridge MW. Feeding schedules
in hospitals for newborn infants. Cochrane Database
Syst Rev 2000;(2):CD000090
Regular breastfeeding
times have been thought to help establish routines and
promote infant digestion, while frequent breastfeeding
has been recommended to enhance breastfeeding and infant
growth. The objective of this systematic review was
to assess the effects of frequent breastfeeding compared
with less frequent breastfeeding in the early days after
birth. Three controlled trials involving 400 women were
included. There were significant method-ological limitations
in some of the studies. Compared to two-hourly, three-hourly
or on demand breastfeeding, restricted (less frequent
four-hourly breastfeeding) was associated with greater
discontinuation of breastfeeding by four to six weeks
postpartum (RR 1.53, 95% CI 1.08 to 2.15). Restricted
breastfeeding was associated with increased incidence
of sore nipples (RR 2.12, 95% CI 1.22 to 3.68), engorgement
(RR 2.10, 95% CI 1.25 to 3.21) and the need to give
additional formula feeds (RR 3.14, 95% CI 1.24 to 8.00).
There appear
to be a number of disadvantages from restricting breastfeeding
to a four- hourly schedule in the first few days after
birth. More frequent or on demand breastfeeding is associated
with fewer complications and longer duration of breastfeeding.
Renfrew
MJ, Lang S, Woolridge M. Oxytocin for promoting successful
lactation. Cochrane Database Syst Rev 2000;
(2): CD000156
A rise in
the concentration of oxytocin causes contraction of
cells around the alveoli and milk ducts, in preparation
for suckling. Lactation failure may result from insufficient
oxytocin. The objective of this systematic review was
to assess the effects of using oral or nasal oxytocin
on lactation. Four controlled trials of 639 women were
included. There was potential for significant bias in
these trials: restricted breastfeeding schedules may
have contrib-uted to inadequate production of milk by
the participants. Sublingual and buccal preparations
of oxytocin were associated with an increase in milk
production. Oxytocin did not appear to increase the
incidence of breast pain and 100 IU of oxytocin appeared
to be slightly more beneficial than 10 IU.
The reviewers
conclude that an appropriate dose of sublingual or buccal
oxytocin may help augment lactation where necessary.
However, if women are encouraged and supported with
unrestricted breastfeeding, the need for oxytocin would
probably be diminished.
Sikorski
J, Renfrew MJ. Support for breastfeeding mothers.
Cochrane Database Syst Rev 2000;(2):CD001141
Exclusive
breastfeeding rates at three to four months remain low
in many health care settings. In economically advantaged
countries, young mothers, those in low-income groups
or those who ceased full-time education at an early
age are least likely to breastfeed. In poorer countries,
more affluent groups may breastfeed less. The objective
of this systematic review was to assess the effects
of breastfeeding support. 13 controlled trials were
included. The relative risk for stopping exclusive feeding
within two months was 0.83 (95% CI 0.72 to 0.96). The
relative risk for stopping breastfeeding within two
months was 0.74 (95% CI 0.65 to 0.86). One more mother
will breastfeed for two months if support is provided
for nine women (95% CI 6 to 21). Similarly, one more
woman will breastfeed exclusively if support is given
to nine women (95% CI 6 to 40).
It is concluded
that the provision of extra support by professionals
with special skills in breastfeeding appears to result
in more mothers breastfeeding their babies until two
months of age, and more mothers breastfeeding their
babies exclusively to two months of age.
Donnelly
A, Snowden HM, Renfrew MJ, Woolridge MW. Commercial
hospital discharge packs for breastfeeding women.
Cochrane Database Syst Rev 2000;(2):CD002075
Exclusive
breastfeeding until around six months of age, followed
by the introduction of solids with continued breastfeeding,
is considered to be the optimal nutritional start for
newborn infants. To determine whether the exclusivity
and duration of breastfeeding is affected by giving
mothers commercial discharge packs in hospital which
contain artificial formula or promotional material for
artificial formula, all randomised controlled trials
that examined the effects of commercial discharge packs
on breastfeeding were systematically reviewed. Nine
randomised controlled trials involving a total of 3,730
women were analysed. The studies only included women
from North America.
The analysis
showed that when comparing commercial discharge packs
with any of the controls (no intervention, non-commercial
pack and combinations of these), exclusive breastfeeding
was reduced at all time points in the presence of commercial
hospital discharge packs. There
was no evidence to support the conjecture that use of
hospital discharge packs causes the early termination
of non-exclusive breastfeeding. Where the introduction
of solid food was measured, giving a commercial pack
(with or without formula) reduced the time before solid
food was introduced.
Prepared
by the Geneva Infant Feeding Association (GIFA),
a member of the International Baby Food Action Network
(IBFAN)
Editors:
Marina Ferreira Rea, Adriano Cattaneo
Copies
of Breastfeeding Briefs sent upon request to GIFA, Avenue
de la Paix 11, 1202 Geneva, Switzerland,
Fax: +41-22-798 44 43, or to UNICEF country offices.
Available
also in French, Spanish, Portuguese and Arabic.
A
contribution of Sfr. 10.-- for a subscription to industrialized
countries is gratefully accepted and can be sent by
international postal order to account no. 12-17653-5
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