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Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a th...

Human milk insufficiency is a significant barrier to implementing breastfeeding, and it is identified as a prevalent concern in 60–90% of mothers in low-and-middle-income countries. Breastmilk insufficiency ca...

Journal of Human Lactation, Ahead of Print.
Introduction:Breastfeeding is a recognized preferred method of infant feeding; however, for many women, difficulties in breastfeeding result in termination before the recommended period of time. Acupuncture is suggested to be a promising option to treat lactation insufficiency and enhance the production of maternal milk.Main Issue:We have reported the case of a woman with lactation insufficiency due to Caesarean section and congenital unilateral invaginated nipple. Milk production started on the 3rd day following delivery. The newborn was not provided with any food or fluids other than mother’s milk. At 5 days of life, the newborn required long feeding periods and lost 4% of his birth weight, with the participant reporting lactation insufficiency described by the perception of inadequate milk production.Management:Despite the implementation of conventional measures to improve lactation, the difficulties in breastfeeding persisted. Acupuncture was tried on Day 6 of life, and enhanced milk production was observed, which could be measured as the volume of residual milk extracted using the breast pump each time after the newborn achieved satiety. After acupuncture treatment there was an augmentation of maternal milk production from both breasts and successful lactation.Conclusion:This case study provides information that might be useful for prospective investigation of acupuncture’s efficacy in women with lactation insufficiency.

Journal of Human Lactation, Ahead of Print.
Introduction:Remdesivir was originally developed to treat Ebola hemorrhagic fever, and its efficacy in treating coronavirus disease 2019 was detected during a preliminary analysis of a randomized controlled trial. It is known that Severe Acute Respiratory Syndrome Coronavirus 2 is not transmitted through human milk, but data about the presence of remdesivir in human milk have been lacking.Main issue:In this case study, we determined the human milk-to-serum drug concentration ratio and the relative dose of Remdesivir in one participant.Management:The participant, a 28-year-old primipara, was found to have Coronavirus 2 infection in 2019, 2 days after delivery. She was given Remdesivir. The Remdesivir concentration in maternal serum and human milk was measured, and the milk-to-serum drug concentration ratio was found to be low (0.089), as was the relative infant dose (0.0070). The participant could not breastfeed her infant during her Coronavirus 2 infection treatment because in Japan anyone with COVID-19 was completely quarantined. However, she was able to resume breastfeeding after discharge and breastfed her infant for 6 months with supplements.Conclusion:Given the low amount of Remdesivir in the participant’s milk, the inclusion of antibodies to Severe Acute Respiratory Syndrome Coronavirus 2, which can be expected to protect the infant from infection, and various other benefits of human milk, suggests that breastfeeding is safe during treatment with Remdesivir.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

The pandemic caused by COVID-19 has affected reproductive and perinatal health both through the infection itself and, indirectly, as a consequence of changes in medical care, social policy or social and econom...

Early initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed ...

The increasing numbers of women in the workforce is an inevitable trend in China. More and more employed women stop breastfeeding because of working stressors. Many mothers, however, overcome the challenges a...

We evaluated (a) opinion of Syrian and Turkish healthcare workers (HCWs), and perceptions and attitudes of Syrian refugee mothers, pregnant women, fathers and grandmothers on age-appropriate breastfeeding, (b)...

Journal of Human Lactation, Ahead of Print.
Background:Suboptimal breastfeeding can result in negative health consequences for mother and infant and economic consequences for families and communities. Breastfeeding outcomes improve when multifaceted interventions spanning the perinatal period are implemented. Incentives to increase participation in effective, existing community-based breastfeeding support programs have the potential to create behavioral change and improve breastfeeding outcomes but results to date are inconclusive.Research Aim:The aim of this pilot study was to investigate the effectiveness of offering a Young Men’s Christian Association membership as an incentive to increase attendance at an existing breastfeeding support program to improve breastfeeding duration and exclusivity.Method:This was a two-group, quasi-experimental study using demographic information and pre- and post-intervention participant surveys. Attendance at a breastfeeding support program was incentivized with an offer of a free family Young Men’s Christian Association membership. Surveys and demographic information were used to compare attendance, maternal interest, and perceived significant other and family support for attendance with a non-incentivized control group in an adjacent city.Results:The groups differed demographically and socioeconomically. Significantly more at-risk participants both attended the incentivized group and perceived support from their families to attend. There was a significant increase in the incentivized group’s attendance: 62% (n = 26) of participants in the incentivized group attended three or more times compared to 36% (n = 50) of participants in the control group (p = .03). Both groups exceeded national breastfeeding averages for exclusive breastfeeding at six months.Conclusion:Offering an incentive increased breastfeeding support group attendance by participants at risk for suboptimal breastfeeding and improved their breastfeeding outcomes, thus closing the breastfeeding disparity gap in this population.

Journal of Human Lactation, Ahead of Print.
Background:Women during the postpartum period undergo significant changes which affect body image, eating behaviors, and, potentially, breastfeeding. There is limited research about relationships among these variables, particularly related to breastfeeding experiences and self-efficacy.Research Aims:To determine: (1) the associations between eating disorder symptoms and body image, breastfeeding self-efficacy, and breastfeeding experiences; and (2) the differences in body image, breastfeeding self-efficacy, breastfeeding experiences, and breastfeeding status of postpartum women with and without clinically significant eating disorder symptoms.Methods:A secondary data analysis using a 2-group correlational, cross-sectional online survey design was used. Participants with infants 2–6 months old who had breastfed their infant at least once (N = 204) were recruited nationally to complete a cross-sectional survey assessing breastfeeding and postpartum physical and mental health using validated measures. Linear and logistic regression evaluated differences between participants with and without eating disorder symptoms regarding their body image, breastfeeding experience and self-efficacy, and breastfeeding status (continued vs. discontinued) at 2 months postpartum.Results:Clinical eating disorder symptoms were reported by 9.8% (n = 20). Participants with clinical eating disorder symptoms reported lower appearance evaluations (B = -0.53, 95% CI [-0.93, -0.14]) and body image satisfaction (B = -0.55, 95% CI [-0.87, -0.23]); reduced odds of breastfeeding at 2 months postpartum (AOR = 0.15, 95% CI [0.04, 0.56]); and lower breastfeeding self-efficacy (B = -7.70, 95% CI [-14.82, -0.58] relative to participants without clinical symptoms. No differences between groups were observed for breastfeeding experiences.Conclusions:Participants with clinically significant eating disorder symptoms are at risk for early breastfeeding discontinuation and lower breastfeeding self-efficacy. Our findings have implications for future research and clinical care practices, including screening for body image concerns and eating disorder symptoms and supporting breastfeeding self-efficacy.

Journal of Human Lactation, Ahead of Print.
Background:No consensus on the definitions of nipple trauma has been reported. Thus, different individuals assess identical events inconsistently.Research Aims:To establish clear definitions for the seven signs of nipple trauma related to breastfeeding—erythema, swelling, scabbing, blistering, fissure, purpura, and peeling—and to reach consensus among multiple specialists.Methods:We implemented a longitudinal, prospective survey design using a 3-step Delphi method. In the first survey we targeted specialists in breastfeeding, dermatology, and cosmetics, and we presented images as representative cases during a set of semi-structured interviews. In the second and third surveys, we questioned midwives who were certified as “advanced midwives” through mail, using a questionnaire prepared based on the results of the first survey. The agreement criteria of this study were as follows: (1) a median of 2.0 or below; (2) an interquartile range of 1.0 or below; and (3) at least 51% showing responses of either “strongly agree” or “agree.”Results:Based on the responses of the 42 experts, we reached a consensus on 48 items: eight related to erythema, 10 to swelling, nine to scabbing, seven to blistering, seven to fissure, four to purpura, and three to peeling. We then classified these items based on the condition or possible mechanism of the wound. Finally, we developed an observation tool: “seven signs of nipple trauma associated with breastfeeding,” along with images.Conclusions:Application of this tool for breastfeeding support could improve objectivity in observing and evaluating nipple trauma.

Journal of Human Lactation, Ahead of Print.
Background:Developing a simple quantitative tool for mastitis diagnosis is essential. The Ion-Selective Electrode for sodium has been reported to reliably measure sodium concentrations in human milk.Research Aim:To determine whether an Ion-Selective Electrode measurement of sodium:potassium ratios could serve as a diagnostic tool for mastitis and, if so, to determine the diagnostic cut-off value.Methods:A total of 107 milk samples, including 55 from milk bank donors and 52 from participants with mastitis, were studied. The sodium:potassium ratios were determined in 33 samples (without mastitis n = 15; with mastitis n = 18) by the Ion-Selective Electrode and ion chromatography. The remaining 74 samples (donor milk n = 40; participants with mastitis n = 34) were analyzed by Ion-Selective Electrode only. Values were averaged over three measurements for each method.Results:The median postpartum months of donors and participants with mastitis were 2 and 3 months, respectively. The mean (SD) sodium:potassium ratios without and with mastitis were 0.5 (0.1) and 1.7 (1.2), respectively. A positive correlation existed between sodium:potassium ratios obtained from the two methods (r = 0.98). Area under the curve values were 0.951 (95% CI [0.904, 0.986]) for the Ion-Selective Electrode (N = 107) and 0.978 (95% CI [0.926, 1.000]) for the ion chromatography (n = 33) methods. The optimal cut-off value for the Ion-Selective Electrode method was 0.60, with 86.5% sensitivity and 92.7% specificity.Conclusions:The Ion-Selective Electrode was sufficiently accurate for the diagnosis of mastitis. Cohort studies are needed to explore the relationship between sodium:potassium ratios and clinical outcomes.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding offers the best nutrition during the first months of life. Scholars have identified a dose-response association between breastfeeding duration and reduced risk for child morbidity and mortality. In upper-middle-income countries, including Mexico, maternal employment has been negatively associated with breastfeeding duration. Despite increasing numbers of women entering the workforce and disproportionately participating in the informal sector, where they are un-entitled to paid maternity leave, little is known about how these factors may affect breastfeeding practices.Research Aim:To determine whether household income moderated the association between maternal employment status (defined as unemployed, formal, and informal full- and part-time employed) and any breastfeeding for ≥ 6 months.Methods:We conducted a cross-sectional study using retrospective secondary data from the 2018–2019 Mexican Health and Nutrition Survey. The analytic sample included data about 2,156 children aged 6–36 months. We computed logistic regression models stratified by household income.Results:The association between maternal employment and breastfeeding duration varied by household income. Compared to unemployed women, among lower-income households, children were less likely to be breastfed for ≥ 6 months when the participants was part-time informally employed (AOR = 0.30, 95% CI [0.13, 0.69]). Among higher-income households, children were less likely to be breastfed for ≥ 6 months when the participants was full-time formally employed (AOR = 0.52, 95% CI [0.30, 0.88]).Conclusions:To increase breastfeeding duration, stakeholders need to continue strengthening and enforcing policies among formally employed women, and strategies are urgently needed to support women in the informal sector, particularly those in lower-income households.

By Popular Demand! We are extending by one week—to February 18—the early-bird pricing for our 2022 Book Group. Register now HERE!!!

How much can you save? Our early-bird pricing is:

• 36 CERPs: $299 (regular price: $350)

• No CERPs: $229 (regular price: $280)

How we connect virtually. This book group incorporates Zoom meetings and Thinkific, an easy-to-use online learning platform. A day or two after you register, you will get an invitation to join us on Thinkific, where you will see the required reading listed for each of our ten sessions.

You will need to get your own copy of Breastfeeding Answers, 2nd Edition, either a hardcover copy or an e-book edition: PDF, Kindle, or ePub (available HERE). The 1st edition (or any of the earlier Breastfeeding Answer Books) will not do! So much has changed! You will read the assigned chapters, attend our live Zoom meetings (or listen to the recording of our live meeting discussion and its Q&A), and review any supplemental materials. If you registered for our 36 CERPs version, you will take the quiz at the end of each session.

When will the book group take place? It will meet from 2:00 to 4:00 pm Eastern time on the following dates: 

• Session 1: Sunday, March 13, 2022

• Session 2: Sunday, March 20, 2022

• Session 3: Sunday, March 27, 2022

• Session 4: Sunday, April 3, 2022

• Session 5: Sunday, April 10, 2022

• Session 6: Sunday, April 24, 2022

• Session 7: Sunday, June 5, 2022

• Session 8: Sunday, June 12, 2022

• Session 9: Sunday, July 10, 2022

• Session 10: Sunday, July 17, 2022

Each session consists of a 2-hour Zoom meeting where we will discuss the materials and answer questions. It includes a 20-minute small-group break-out discussion of the practical applications of that session’s material. Before each session, you will read the assigned chapters (some sessions cover one chapter, and others cover two or three) and any supporting materials. If you registered for CERPs, after our Zoom meeting, you will take a short quiz.

You must buy the most recent book: Breastfeeding Answers, 2nd Edition by Nancy Mohrbacher (available HERE).

The Zoom meetings will be recorded so you have the flexibility of missing any or all of the live session if needed and then listening to them at your leisure on Thinkific. You will have access to all the materials until September 1, 2022.

To learn more about the book group, watch our short video below. You can also listen HERE to the free 30-minute book-group podcast I recorded with Barbara.

Hope you can join us!