Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
Background:Lack of breastfeeding support is a common barrier reported by African American mothers, whose breastfeeding rates remain significantly below the national average. Despite mothers’ reported use of social network sites to access support on topics relating to child rearing, few studies have examined their use to exchange breastfeeding support.Research aims:To describe (1) the experiences of African American mothers who participate in breastfeeding support groups on Facebook and (2) the breastfeeding beliefs, practices, and outcomes for this population of mothers.Methods:This was a prospective, cross-sectional qualitative study with an online focus group design. The study was guided by Black Feminist Thought and an integrated model of behavior prediction. Four online focus groups (N = 22) were conducted using video conferencing during September 2017 with African American mothers who were participating in breastfeeding support groups on Facebook.Results:Thematic analysis was used to develop four themes and two subthemes, including creating a community for Black mothers, online interactions and levels of engagement, advantages of participating in online support groups, critiques of online support groups, empowerment of self and others, and shifts in breastfeeding perceptions and decisions. Among participants in this study, positive imagery of African American breastfeeding mothers and ongoing support from women with shared experiences improved confidence with public breastfeeding and prolonged goals for breastfeeding duration.Conclusion:Receiving peer support within Facebook communities may positively influence breastfeeding norms and confidence in breastfeeding, help mothers to overcome breastfeeding challenges, and ultimately extend intended breastfeeding duration.

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.
Background:Prenatal care providers play a central role in breastfeeding outcomes. A survey on obstetricians’ support of breastfeeding was conducted in 1993 in Monroe County, NY. Since the landscape of prenatal care and breastfeeding support has changed significantly in the past 2 decades, we repeated and extended this survey in 2015.Research aim:To determine changes in breastfeeding support by prenatal care providers over a 20 year period.Methods:We sent a 46-item on-line or paper questionnaire to all categories of prenatal care providers identified by an online search. A breastfeeding support score was created based on the prior survey, with a maximum score of 3. One point was awarded for: (1) personally discussing breastfeeding; (2) generally suggesting breastfeeding; and (3) commonly receiving questions from patients. Data were analyzed using Chi-square.Results:We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p < .001) and recommending (93% vs. 80%, p = .001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p < .0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p < .001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p < .0001).Conclusion:Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.

Journal of Human Lactation, Ahead of Print.
Background:Prenatal care providers play a central role in breastfeeding outcomes. A survey on obstetricians’ support of breastfeeding was conducted in 1993 in Monroe County, NY. Since the landscape of prenatal care and breastfeeding support has changed significantly in the past 2 decades, we repeated and extended this survey in 2015.Research aim:To determine changes in breastfeeding support by prenatal care providers over a 20 year period.Methods:We sent a 46-item on-line or paper questionnaire to all categories of prenatal care providers identified by an online search. A breastfeeding support score was created based on the prior survey, with a maximum score of 3. One point was awarded for: (1) personally discussing breastfeeding; (2) generally suggesting breastfeeding; and (3) commonly receiving questions from patients. Data were analyzed using Chi-square.Results:We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p < .001) and recommending (93% vs. 80%, p = .001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p < .0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p < .001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p < .0001).Conclusion:Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.

Journal of Human Lactation, Ahead of Print.
Introduction:Childbearing women with primary or secondary Herpes Simplex Virus type 1 infection are at risk of transmitting neonatal herpes infection to their infants; a medical emergency that is associated with high mortality and morbidity. Neonatal herpes infection has been commonly associated with Herpes Simplex Virus type 2, or genital herpes, but can be caused by either subtype and the presentations are indistinguishable. This case describes the course of diagnosis, treatment, and recovery for a mother and infant during a severe maternal and neonatal herpes infection, and how lactation was maintained and breastfeeding re-established. Our children’s hospital coordinated its efforts to assist and monitor this breastfeeding family, and they were able to resume breastfeeding soon after discharge. It is our opinion that it is imperative that mothers receive evidence-based lactation care to maintain their breastfeeding relationship during extended hospital stays.Main Issue:An acutely ill infant was admitted to our urban children’s hospital with severe neonatal herpes infection for a total of 3 weeks. His mother was severely affected on her breasts and she required a brief hospitalization. The mother’s breasts were covered with draining herpetic lesions that required daily dressing changes. However, her lesions were slow to heal, and a wound care consultation was facilitated and her treatment plan was adjusted. We were surprised that she experienced minimal discomfort with pumping and dressing changes. The mother maintained a positive outlook, complied with the plan to express frequently to maintain milk production, and was able to breastfeed again when they both recovered.Management:This mother received immediate support and appropriate pumping equipment from our hospital personnel and was subsequently able to establish and maintain her milk supply. The difficulty in this case was the management of the mother’s extensive herpetic wounds that were slow to heal. A certified wound care specialist was required. Both mother and child recovered from their infections and were able to restart breastfeeding; eventually reaching their goal of breastfeeding for 2 years.Conclusions:Neonatal herpes infection is a potentially fatal disease and maternal child health professionals should have a high suspicion for any ill-appearing newborn with or without a rash. When a breastfeeding infant and mother become infected with Herpes Simplex Virus type 1, it is the responsibility of the healthcare institution to support lactation and the return to breastfeeding rather than recommend cessation of lactation, which is rarely necessary. A multi-disciplinary evidence-based approach to lactation care is essential to preserve lactation during infant hospitalization.

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.

Journal of Human Lactation, Ahead of Print.
Background:In Italy, there is no widespread standardized national monitoring system for breastfeeding practices.Research aims:To estimate breastfeeding indicators according to World Health Organization recommendations and associated socioeconomic factors, highlighting the potential and limitations of vaccination centers as sources of data.Methods:A cross-sectional study was conducted in the vaccination centers of 13 Local Health Districts in Italy. Data on breastfeeding practices were collected via structured questionnaires between February and November, 2015, from 14,191 mothers recruited during vaccination appointments for the 1st, 2nd and 3rd doses against Diphtheria, Tetanus, and Pertussis, and for the 1st dose against Measles, Mumps, and Rubella. Crude breastfeeding rates and direct age standardized rates were compared. Logistic regression models were used to explore socio-demographic characteristics associated with breastfeeding indicators.Results:Overall, 14,191 mothers were recruited, with a response rate higher than 94%. Exclusive breastfeeding rates among children aged 2–3 months and 4–5 months were 44.4% and 25.8%, respectively; breastfeeding rates among children aged 11–12 and 13–15 months were 34.2% and 24.9%; 10.4% never breastfed. Strong geographical and socioeconomic differences were found. Some differences also emerged between crude and standardized rates.ConclusionsWe conclude that a survey system in vaccination centers is practicable and its use could produce, with standardized methodology, representative regional and national breastfeeding estimates that could monitor progress towards present and future targets.

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.
Background:Researchers exploring breastfeeding attitudes and knowledge among women suggest the decision to breastfeed is influenced by the male partner, yet few studies address males. Because collegiate males will soon enter fatherhood, assessment of their attitudes and knowledge may inform interventions aimed at increasing intention to breastfeed.Research aim:This study aimed to describe collegiate males’ exposure to, attitude toward, and knowledge about breastfeeding.Methods:A cross-sectional online survey was used with males ≥ 18 years of age enrolled at a Texas public university. Attitude indices measured included social limitations, public displays of breastfeeding, and employer accommodations. Descriptive statistics, correlational and regression analyses were employed.Results:The participants’ (N = 949) average age was 25.48 years; > 80% reported not being fathers. Exposure to breastfeeding was high; > 80% witnessed breastfeeding and/or had someone close breastfeed. High attitude scores indicated social acceptability of breastfeeding. Knowledge appeared limited: only 16% identified the recommendation of exclusive breastfeeding for the first 6 months of life; > 50% overlooked the reduced risk for overweight/obesity, ear infections, diarrhea, or food allergies. Correlations between knowledge, exposure, total attitude, and index scores were positive (p < .01) except for the public displays index. Stepwise multiple regression determined that breastfeeding exposure, knowledge scores, and father’s educational level predicted total attitude score, (R2 = 0.13, F (3,851) = 44.02, p < .01).Conclusion:The positive attitudes outcome among this male population is promising for breastfeeding support and advocacy. Education efforts improving knowledge will likely increase behavioral intention, resulting in increased breastfeeding rates and duration.

Journal of Human Lactation, Ahead of Print.
Background:Infant tongue-tie can cause breastfeeding problems, which may be improved by frenotomy. However, controversy exists among the medical community.Research aim:To examine the influence of frenotomy on infants with posterior ankyloglossia, by quantifying the changes in breastfeeding and maternal nipple pain using standardized tools.Methods:Newborns (N = 30) below 12 weeks of age were recruited from the Herzl–Goldfarb Breastfeeding Clinic between April 2014 and April 2015. Diagnosis of posterior ankyloglossia was made clinically. Frenotomy was performed. Mothers received breastfeeding counseling before and after the procedure. Pain and breastfeeding were assessed before the procedure, immediately after the procedure, and after 2 days, 7 days and 14 days. Breastfeeding was assessed using the LATCH Tool and by subjective questioning. Maternal nipple pain was assessed using the Numeric Rating System.Results:No complications were reported with frenotomy. There was a significant improvement in LATCH score immediately post-frenotomy, with an increase in median scores from 7.5 to 8.5 (p < .0001, Wilcoxon signed rank test). There was a significant decrease in median pain score immediately post-frenotomy, from 3.0 on the left nipple and 3.25 on the right nipple, to 0 bilaterally (p < .0001, Wilcoxon signed rank test). Subjective improvement in breastfeeding was reported by 90% of mothers immediately after frenotomy and 83% of mothers at Day 14.Conclusion:Frenotomy for posterior ankyloglossia may improve breastfeeding and nipple pain.