Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundTandem breastfeeding is defined as two or more offspring of different ages who are breastfed by their mother at the same time. Breastfeeding during pregnancy and tandem breastfeeding have not been widely investigated.Research AimTo determine the influence of tandem breastfeeding on the macronutrient content of human milk.MethodsThis longitudinal study used a prospective and a retrospective group. Human milk samples from tandem-breastfeeding participants (n = 18) were compared to samples from non-tandem-breastfeeding participants (n = 31). Samples were collected during the last month of pregnancy (pregnancy milk), 72 hr after birth (colostrum) and 14–60 days post-delivery (mature milk). Macronutrients were measured by mid-infrared spectroscopy.ResultsFat content in pregnancy milk was lower than in mature milk (p < .01). Protein content was higher in pregnancy milk than in colostrum and mature milk (p < .01 and p < .001, respectively). Inversely, carbohydrate content in pregnancy milk was lower than in colostrum and mature milk (p = .02 and p < .01, respectively). Fat and energy contents in pregnancy milk of tandem-breastfeeding participants were lower than in mature milk of non-tandem-breastfeeding participants (p < .001 and p < .01, respectively), and protein content was higher than in mature milk (p < .001). Carbohydrate content in colostrum and mature milk of tandem-breastfeeding participants was higher than that of non-tandem-breastfeeding participants (p < .001 for both).ConclusionHuman milk produced during pregnancy had different macronutrient content than human milk produced after delivery. Colostrum and mature milk of tandem-breastfeeding participants were similar to human milk produced by non-tandem-breastfeeding participants, with the exception of carbohydrate content.

Journal of Human Lactation, Ahead of Print.
BackgroundPandemic-related restrictions have limited traditional models of lactation support.Research AimsThe primary aim of this study was to determine changes to breastfeeding support services during the coronavirus-2019 pandemic according to trained lactation providers. The secondary aim was to assess strengths and limitations of telehealth services.MethodsA prospective survey was conducted entirely online using the Qualtrics platform during June 2020. Gatekeepers at Connecticut agencies and breastfeeding networks were forwarded an anonymous survey link to distribute to eligible lactation staff.ResultsA variety of participants (N = 39) completed the survey and the majority (69.2%; n = 27) were providing only telehealth services. More than half (58.1%; n = 18) of the participants who conducting telehealth in any form, found that virtual lactation support was moderately effective compared to in-person support. Weakness of virtual support included technical and logistical difficulties, challenges assisting with latching or reading body language over the phone or online, and accurately assessing infant growth. Strengths related to virtual support included the flexibility and convenience of home-based support, expanded communication strategies, and safety from virus exposure. Further, visits with a lactation professional decreased significantly during the pandemic. Limited in-hospital and pediatrician support were also noted, particularly among groups without access to telehealth resources.ConclusionsAs a result of the pandemic and associated shifts in lactation services, breastfeeding disparities may be further exacerbated among those without equitable access to lactation support. Challenges and innovations in virtual support may influence adaptive options in the field moving forward.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundMaternal worry about infant weight has inconsistently been reported as a breastfeeding barrier. Weight monitoring is a critical tool to assess adequacy of infant feeding. Yet, little is known about the intensity of maternal worry about infant weight or associated breastfeeding outcomes.Research aimsTo examine (1) the frequency and intensity of maternal worry about infant weight; (2) the relationship between worry about weight and use of artificial milk; and 3) the relationship between worry about weight and breastfeeding cessation.MethodsA prospective cross-sectional design was used. A questionnaire was completed by women in the United States (N = 287) from 12 web-based maternal support groups.ResultsSixty-three percent of women (n = 182) had some worry about infant weight. Participants breastfeeding for the first time had more worry (p = .035). Participants still breastfeeding had less worry about weight compared to those who had stopped (67%, n = 147 vs. 41%, n = 28). Exclusive breastfeeding participants had less worry (p < .001) compared to those who supplemented with artificial milk. Increased worry was associated with the use of artificial milk within 1 week of birth (p < .001) and early breastfeeding cessation (p < .001).ConclusionsWorry about weight is a significant breastfeeding barrier. It is associated with first time breastfeeding, less exclusive breastfeeding, use of artificial milk, and earlier breastfeeding cessation. Lactating mothers need anticipatory guidance about expected neonatal weight changes and interventions to help relieve worry about infant weight.

Journal of Human Lactation, Ahead of Print.
BackgroundMany individuals comprise a nursing mother’s social support network. Grandmothers within African American families, historically, have played a vital role in the transmission of culture. Understanding intergenerational perspectives within African American families related to infant feeding and scholarship about breastfeeding is critical, given the breastfeeding patterns among African American women.Research aimTo describe intergenerational perspectives within African American families, where the mother has successfully breastfed.MethodsA prospective, cross-sectional, qualitative design using semi-structured interviews was used. African American nursing mothers and maternal grandmothers (N = 14) residing in the Metro–St. Louis area, who reflected economic and educational diversity, were recruited. Inductive and iterative data analysis, framed by Black Feminist Theory allowed for emerging patterns reflecting the participants’ voices.ResultsThree of the six (50%) grandmother participants had breastfed. The majority of the mother participants were married (n = 5; 62.5%) and had a college degree (n = 4; 50.0%) or a high school diploma (n = 1; 12.5%); and four (50.0%) had received the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Three patterns emerged: (a) intergenerational connections; (b) changes in breastfeeding experiences over time; and (c) going with the flow (referring to the choice to work within the constraints of one’s circumstances). Grandmothers supported mothers’ breastfeeding decisions; grandmothers who had breastfed benefited from the updated information the mothers provided; and grandmothers who did not breastfeed acquired new breastfeeding knowledge, which informed the ways they supported the mothers.ConclusionThe intergenerational perspectives surrounding breastfeeding within African American families participating in this study offer future research directions.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Wet-nurses themselves rarely left written accounts. In this article, I have reconstructed their experiences and work situations breastfeeding other women’s infants in colonial Australia through examining available sources concerning their employment situations and the fate of their infants when they were boarded out, as they commonly were. The employment of wet-nurses by royal households or prominent families has long been the topic of historical accounts, whereas the situation of the more numerous wet-nurses further down the social spectrum has received disproportionately little examination. In this article, I do not discuss informal, altruistic wet nursing by family or neighbors but, rather, the situation of those women for whom it was an occupation, by its very nature short term. Primary material sighted for this study included a considerable number of advertisements for positions placed by employers, their intermediaries (e.g., family physicians) and wet-nurses themselves, and newspaper reports when the wet-nurse’s children came to the attention of the courts. Death for boarded-out infants who succumbed to inappropriate feeding and substandard care was typically ascribed to “natural causes.”

Journal of Human Lactation, Ahead of Print.
BackgroundDietary long-chain polyunsaturated fatty acids are known to benefit infant development. After birth, human milk provides arachidonic, eicosapentaenoic, and docosahexaenoic acids to the infant. Endocannabinoids are endogenous lipid mediators derived from the long-chain polyunsaturated fatty acids. Although the roles and the mechanisms of action are not fully understood, previous researchers have suggested that endocannabinoids might play a role in infant feeding behavior.Research AimsTo assess (i) maternal dietary intake of long-chain polyunsaturated fatty acids and (ii) their relationship to concentrations of fatty acids and derived endocannabinoids in human milk.MethodsFor this exploratory-longitudinal study, participants (N = 24) provided dietary intake data and milk samples. Fatty acids and derived endocannabinoids: Arachidonylethanolamide, arachidonoylglycerol, docosahexaenoyl glycerol, eicosapentaenoyl ethanolamide, and eicosapenaenoyl glycerol were identified in their milk by liquid chromatography-mass spectrometry and correlations to dietary fatty acids were assessed.ResultsParticipants were not consuming recommended amounts of docosahexaenoic acid. Significant correlations (p ≤ .05) were only found between dietary docosahexaenoic and eicosapentaenoic acids and the concentrations of these in human milk. Moreover, only dietary docosahexaenoic acid was correlated (p = .031) with its corresponding endocannabinoid, docosahexaenoyl glycerol.ConclusionsTo the best of our knowledge, this may be one of the first studies evaluating relationships between dietary long-chain polyunsaturated fatty acids and multiple endocannabinoids in human milk. Our findings suggest that endocannabinoid concentrations could be modulated by dietary precursors. Future research studies can be designed based on these data to better elucidate the roles of endocannabinoids in human milk for infant health and development.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
In this issue’s Lactation Newsmakers: Documenting our History, we are featuring two emerging leaders in the field of lactation. Rachel Davis and Janiya Williams are both International Board Certified Lactation Consultants and hold positions as directors for the only two Pathway 2 Lactation Consultant Training Programs in Historically Black Colleges / Universities. Rachel is Program Director for the Lactation Consultant Training Program at Johnson C. Smith University in Charlotte, North Carolina, while Janiya directs the Human Lactation Training Program at North Carolina Agricultural and Technical State University an hour and a half away in Greensboro, North Carolina. While their backgrounds are quite different, both women care passionately about increasing diversity and equity in the field of lactation support, as well as normalizing nursing for Black and brown families transitioning into parenthood. In this interview they speak to relationships they have developed with their students, their students have developed with each other, and the strength of community created within and between their programs. They describe the difficulties their students encounter with institutional racism within the medical system, and the additional preparation they receive to navigate it. Both programs experience high volumes of applicants—almost 350 for the 12 positions at Johnson C. Smith University—demonstrating the significant need for this curriculum in Historically Black Universities/Colleges. The importance of this model in diversifying the field of lactation cannot be underestimated, and the outspoken women doing this work will be influencers in this field for years to come. (RD = Rachel Davis; JW = Janiya Williams; EC = Ellen Chetwynd).

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundBreast/Chestfeeding remains a public health issue for African Americans, and increased rates would mitigate many health disparities, thus promoting health equity.Research AimsTo explore the interplay of generational familial roles and meaning (or value) ascribed to communicating infant feeding information across three generations.MethodThis prospective, cross-sectional qualitative study used an asset-driven approach and was guided by Black Feminist Thought and Symbolic Interactionism. African American women (N = 35; 15 family triads/dyads), residing in the southeastern United States were interviewed. Data were analyzed using thematic analysis.ResultsThe older two generations described their role using assertive yet nurturing terms, while the younger generation carefully discussed the flexibility between their familial roles. Emergent themes described the meaning each generation attributed to communicating infant feeding information: “My Responsibility,” “Comforting,” “Bonding Experience,” “She Cared,” and “Gained Wisdom.”ConclusionsOur findings have potential to contribute to achieving health equity in African American families. Future breast/chestfeeding promotion efforts may benefit from reframing the current approach to including protection language and not solely support language. Lactation professionals should further recognize and support strengths and resource-richness of intergenerational infant feeding communication within African American families using strength-based, empowerment-oriented, and ethnically sensitive approaches.

Journal of Human Lactation, Ahead of Print.
BackgroundThe Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, adherence of hospitals to the Baby-Friendly 10 Steps, as determined from the perspective of women participating in the United States Special Supplemental Nutrition Program for Women, Infants, and Children, has not been assessed.Research Aims(1) To compare maternal perceptions about maternity practices in Baby-Friendly Hospitals and non-Baby-Friendly Hospitals; (2) to evaluate the associations between degree of exposure to the Baby-Friendly 10 Steps and breastfeeding practices through the first 6 months; and (3) to evaluate whether the receipt of specific Steps was associated with breastfeeding practices through 6 months.MethodsThis study was a cross-sectional 2 group comparison, using prospective data collected through a self-report telephone survey and retrospective data gathered from participants’ records. Women (N = 182) participating in four Maryland Special Supplemental Nutrition Program for Women, Infants and Children agencies were recruited. One hundred and eight (59%) participants delivered at designated Baby-Friendly Hospitals; 74 (41%) delivered in non-Baby-Friendly designated hospitals. Logistic regression models were utilized to determine the influence of perceived Step adherence on exclusive breastfeeding.ResultsReported adherence to 10-Steps policies ranged from 10%–85% (lowest for Step 9, highest for Step 10) and only Step 9 (give no pacifiers or artificial nipples to breastfeeding infants) differed according to Baby-Friendly Hospital status. Greater exposure to the 10 Steps was positively associated with exclusive breastfeeding during hospitalization. The lack of perceived adherence to Step 6 (no food or drink other than human milk), Step 9, and the International Code of Marketing of Breast-milk Substitutes (no formula, bottles, or artificial nipples) significantly decreased the likelihood of exclusive breastfeeding through 6 months.ConclusionMaternal perception of Baby-Friendly Step adherence was associated with exclusive breastfeeding.

Journal of Human Lactation, Ahead of Print.