Hírolvasó

Journal of Human Lactation, Ahead of Print.
Background:In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4–5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices.Research aim:To identify the main barriers to optimal breastfeeding practices in Armenia.Methods:We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches.Results:We identified two main categories of barriers to optimal breastfeeding—systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers—mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers.Conclusion:Optimal breastfeeding is crucial for the best start to an infant’s life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:To better track progress in achieving the Healthy People 2020 goals, the Centers for Disease Control and Prevention (CDC) publishes an annual Breastfeeding Report Card (BRC) that represents a compilation of data on breastfeeding practices in all states. With data drawn from the CDC National Immunization Survey, the BRC provides an especially valuable source of information about geographic trends in breastfeeding and related support activities.Research aim:This study aimed to identify important geographic trends in both breastfeeding practices and support structures in the United States, highlighting their spatial disparities.Methods:Exploratory spatial data analysis, including local indicators of spatial association, is combined with spatial regression models to highlight geographic variations in breastfeeding practices and support.Results:Geographic variation in both breastfeeding practices and allied support exists within the United States. Geographic hot spots of breastfeeding are found in the western and northeastern sections of the United States, and cool spots are located primarily in the Southeast. Regression results suggested that unemployment and demographic diversity are negatively associated with breastfeeding rates, whereas higher education and the presence of International Board Certified Lactation Consultants® (IBCLCs®) are positively connected to persistent breastfeeding practices. Further, although the availability of professional support (IBCLC) strengthened nationwide between 2011 and 2016, the availability of mother-to-mother support (La Leche League) softened.Conclusion:Although breastfeeding initiation rates continue to increase in the United States, rates of exclusive breastfeeding at 3 and 6 months remain low, displaying significant geographic variation. The ability to pinpoint lagging regions can help to efficiently allocate additional breastfeeding support resources and interventions.

Journal of Human Lactation, Ahead of Print.
Background:International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants.Research aim:To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC’s role.Methods:The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008–2019. Qualitative and quantitative studies were reviewed.Results:Twelve (N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC’s role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed.Conclusion:In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
There has, historically, been a lack of consistency in the use and definition of terms and their associated measurement in breastfeeding research. The purpose of this paper is to promote consistency through a taxonomy and lexicon for population-based breastfeeding research with the modern nursing dyad. The taxonomy organizes concepts in categories related to research on feeding human milk to infants, noting the perspective from the provider of human milk (parent or alloparent) and the receiver of human milk (child). The taxonomy includes these categories: psychology, physiology, behavior, and modality. The intensity of behaviors and modalities can be characterized qualitatively or quantitatively. Other terms are introduced or defined for the modern era and measurement standards are posed. These suggestions invite discussion and debate, in an effort to move researchers toward consistent measurement, documentation, and presentation, to build a credible evidence base for breastfeeding and practices related to the provision and consumption of human milk.

Journal of Human Lactation, Ahead of Print.
Background:International Board Certified Lactation Consultants (IBCLC) are healthcare professionals who are highly trained in lactation science; however, little is known about the efficacy of IBCLC-specific support on breastfeeding outcomes.Research aims:This systematic review and meta-analysis aimed to describe interventions containing direct support by IBCLCs during the postpartum period and to analyze the association between study characteristics and the prevalence breastfeeding outcomes.Methods:Electronic databases were searched for studies published between January 2001 and December 2018. Meta-analysis and meta-regression were performed on studies containing breastfeeding prevalence data at 3 or 6 months postpartum.Results:Seventeen interventions met all inclusion and exclusion criteria and eight research teams reported the prevalence of any or exclusive breastfeeding at 3 and/or 6 months. For any breastfeeding at 6 months, the pooled difference was 0.08 [0.04, 0.12] meaning we’d expect to observe 1 additional case of any breastfeeding at 6 months postpartum for every 12 women who received an IBCLC intervention, 95% CI [8, 25] rather than control conditions. Results differed depending on which outcome variable was used to measure breastfeeding and the timing of that measurement.Conclusions:Breastfeeding interventions that include IBCLC support in the postpartum period have potential for improving breastfeeding outcomes; however, when designing interventions, the timing and method of data collection for measures of breastfeeding are instrumental to study sensitivity and need to be based on the aims of the intervention itself.

Journal of Human Lactation, Ahead of Print.
Breastfeeding is critical for the healthy growth and development of infants. A diverse range of infant-feeding methods are used around the world today. Many methods involve feeding infants with expressed human milk obtained through human milk exchange. Human milk exchange includes human milk banking, human milk sharing, and markets in which human milk may be purchased or sold by individuals or commercial entities. In this review, we examine peer-reviewed scholarly literature pertaining to human milk exchange in the social sciences and basic human milk sciences. We also examine current position and policy statements for human milk sharing. Our review highlights areas in need of future research. This review is a valuable resource for healthcare professionals and others who provide evidence-based care to families about infant feeding.

It may be tempting for breastfeeding advocates to respond to challenges of breastfeeding older children or breastfeeding in public, by pointing out the nutritional or developmental benefits of breastfeeding, o...

Journal of Human Lactation, Ahead of Print.
Breastfeeding and the place of sleep for the mother and the infant have been controversial internationally due to reported concerns regarding infant deaths despite the known benefits of exclusive and prolonged breastfeeding, which are increased by breastfeeding at night. The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice. Despite well-meaning but unsuccessful campaigns in some countries to dissuade parents from sleeping with their babies, many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. Taking cultural contexts and socio-ecological circumstances into consideration, data supports policies to counsel parents and caregivers on safe sleep practices, including bed-sharing in non-hazardous circumstances, particularly in the absence of parental smoking, recent parental alcohol consumption, or sleeping next to an adult on a sofa. Further research with appropriate methodology is needed to drill down on actual rates of infant deaths, paying close attention to the definitions of deaths, the circumstances of the deaths, and confounding factors, in order to ensure we have the best information with which to derive public health policy. Introduction and use of the concept of “breastsleeping” is a plausible way to remove the negative connotations of “co-sleeping” and redirect ongoing data-driven discussions and education of best practices of breastfeeding and sleep.

Decisions about infant feeding are embedded and are continuously made within a woman’s social and cultural context. Despite the benefits of breastfeeding to both women and infants, and government policies and ...

In 2015, the popular online parenting forum, Netmums, named breastfeeding selfies as the number one parenting trend in the UK for that year. Public reaction to the rise in popularity of this practice is polarised...

Significant efforts by governments at a global and national level have not resulted in a significant increase in the duration of breastfeeding to six months. The views of family and social networks, and commun...

Authored by: Sarah Shubeck, MD and Megan Pesch, MD, MS The culture of medical training and demands of residency work is often regarded as not conducive to the needs of lactating physicians. The need for “breaks” or perceived lack of dedication to workplace can lead to misperception of lactating trainees and pressures to stop milk […]

With an increasing demand for mother’s own milk to be viewed as a primary source of nutritional support in the care of very small and preterm infants, mothers of preterm infants may be at risk of expressing su...

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Reducing maternal mortality is a key focus of development strategies and one of the indicators used to measure progress towards achieving the Sustainable Development Goals. In the absence of medical certificat...

The relevance of registries as a key component for developing clinical research for rare diseases (RD) and improving patient care has been acknowledged by most stakeholders. As recent studies pointed to severa...