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, Box
157, 1211 Geneva 19, Switzerland, Fax: +41-22-798 44 43,
or to UNICEF country offices.
Available
also in French, Spanish, Portuguese and Arabic.
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