Face-to-face health professional contact for postpartum women: A systematic review.

The postpartum period is a time when physical, psychological and social changes occur. Health professional contact in the first month following birth may contribute to a smoother transition, help prevent and manage infant and maternal complications and reduce health systems' expenditure. The aim of this systematic review was to assess the effect of face-to-face health professional contact with postpartum women within the first four weeks following hospital discharge on maternal and infant health outcomes. Fifteen controlled trial reports that included 8332 women were retrieved after searching databases and reference lists of relevant trials and reviews. Although the evidence was of moderate or low quality and the effect size was small, this review suggests that at least one health professional contact within the first 4 weeks postpartum has the potential to reduce the number of women who stop breastfeeding within the first 4-6 weeks postpartum (Risk Ratio 0.86 (95% Confidence Interval 0.75-0.99)) and the number of women who cease exclusive breastfeeding by 4-6 weeks (Risk Ratio 0.84 (95% Confidence Interval 0.71-0.99)) and 6 months (Risk Ratio 0.88 (95% Confidence Interval 0.81-0.96). There was no evidence that one form of health professional contact was superior to any other. There was insufficient evidence to show that health professional contact in the first month postpartum, at a routine or universal level, had an impact on other aspects of maternal and infant health, including non-urgent or urgent use of health services.

From Liminality to Vitality: Infant Feeding Beliefs Among Refugee Mothers From Vietnam and Myanmar.

Infant feeding in traditional (non-White societies) is imbued within beliefs surrounding the human body and food. This article, framed within the liminality theory, demonstrates perspectives of 38 Vietnamese and Myanmarese refugee mothers. Situated within the postmodern methodological framework, innovative methods of in-depth interviewing and drawing were used to gather participant's subjectivities. As birthing renders the new mother and infant weak, the findings mirror a "liminality to vitality" nurturing continuum, acknowledging the (a) essentialism of bodily breast milk, (b) rituals that strengthen mothers for lactation, (c) lactation-inducing food, and (d) culturally symbolic non-milk food that promote an independence for nourishment other than from the maternal body. Health care professionals are called to value the importance of bodily vitality in birthing and clinical maternal-child health/nutrition spheres so that culturally specific services and consultations are rendered. Our findings also offer a platform to developing models of care for families from Vietnamese and four ethnic Myanmarese communities.

Postpartum breastfeeding experiences in the traditional-biomedical crossroads: A qualitative study using drawing with Vietnamese and Myanmarese refugee women in Australia.

AIMS: To explore how postpartum support networks, hospital stay and healthcare services had an impact on breastfeeding experiences of refugee women from Vietnam and Myanmar in Brisbane, Australia. DESIGN: A qualitative study guided by feminist methodological inquiry. METHODS: Semi-structured interviews and drawing exercises were conducted with recent (<10 years) and established (≥10 years) refugee women between July 2015 - June 2016. Verbal data were analysed thematically, whereas drawings were analysed with the critical visual analytical framework. RESULTS: The findings reflect how 36 mothers negotiated their breastfeeding experiences in the "traditional-biomedical" intersection (major theme) in face of changing support networks, social structures, hospital policies and postpartum services postresettlement (sub-themes). Tensions of cultural unfamiliarity in the western setting generally contributed to early breastfeeding cessation among recent arrivals, whereas social (extended families, tertiary education) and cultural (English literacy) capitals and a longer stay in Australia enabled established arrivals to integrate the traditional and western biomedical beliefs. CONCLUSION: The ability of established arrivals to integrate both traditional and western worldviews may assist in addressing breastfeeding uncertainties that affect recent arrivals. Perspectives of midwives from the western postnatal spheres merit future exploration. IMPACT: Positive early breastfeeding experiences lead to its long-term success. By identifying the impact that conflicting beliefs have on breastfeeding experiences of refugees in the western biomedical environment, this study suggests how interventions that focus on reinforcing maternal cultural and social capital could benefit community empowerment, healthcare and policy sectors nationally and globally.

"Fitting-in Australia" as nurturers: Meta-synthesis on infant feeding experiences among immigrant women.

PROBLEM: Migration or resettlement to western nations frequently alters breastfeeding and complementary feeding practices. BACKGROUND: Infant feeding practices in traditional societies (originally from non-white countries) are ingrained within customary beliefs and practices. AIM: To understand maternal infant feeding experiences pre- and post-resettlement for the benefit of policy and healthcare practice. METHODS: This meta-synthesis of qualitative studies on infant feeding experiences of migrant and refugee women in Australia adopted the Noblit and Hare aproach. CINAHL, ScienceDirect, MEDLINE, Social Sciences, SCOPUS and PubMed databases from 1980 to 2018 were searched. Fourteen papers of the 218 retrieved met the inclusion criteria. The Critical Appraisal Skills Programme (CASP) tool was used to assess the quality of papers and data were synthesised through reciprocal translation. RESULTS: One overarching theme emerged: "Fitting-in" to nurture a healthy child in a new homeland. This theme composed of two major themes: beliefs about breast milk and breastfeeding; and beliefs about complementary feeding. In Australia, manufactured foods such as infant formula were often associated with modernism. Western hospital policies were seen as a deterrent to lactation, while familial disconnections and unfamiliarity with healthcare and societal norms undermined maternal infant feeding confidence. New to the scope of migratory infant feeding literature, this synthesis uncovers how migrants and refugees negotiated the western hierarchical structures differently due to issues of power differences. CONCLUSION: The 'Fitting-in' notion is best described through the socio-ecological model and maternal capital possessions. This paper calls for a proper 'balancing' between traditional beliefs and the safeguarding of infant health.

Breastfeeding questions to medicines call centres from the Australian public and health professionals.

There is considerable uncertainty regarding medication use during breastfeeding. This study compared lactation-related questions about medicines from consumers and health professionals to identify knowledge gaps. A retrospective, mixed-methods study of lactation-related call data extracted from two Australian medicines call centre databases: National Prescribing Service (NPS) Medicines Line (ML) for the general public and Therapeutic Advice and Information Service (TAIS) for health professionals, was conducted. Of the 5662 lactation-related calls by consumers to ML, most were from women enquiring about themselves (95%). The 2219 lactation-related calls from health professionals to TAIS were largely from GPs (46%), community pharmacists (35%) and nurses (12%). Consumers commonly enquired about medicines freely accessible or over-the-counter, including non-steroidal anti-inflammatory products (9.3%), paracetamol (6.9%), ibuprofen (4.8%) and codeine (4.2%). Health professionals' questions involved prescription medicines such as antidepressants (16.9%), with queries on sertraline (3.7%), levonorgestrel (2.7%) and domperidone (2.4%) most common. Question themes were similar for both cohorts, focusing mainly around medication safety, risk minimisation and milk supply. Understanding the compelling and common themes driving medicines help-seeking related to breastfeeding is key to addressing information gaps and improving overall medication use during breastfeeding.

ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Barriers and enablers to postpartum contraception among Aboriginal Australian women: factors influencing contraceptive decisions.

This qualitative research obtained insights into factors influencing postpartum contraception use among Aboriginal women in southern Queensland. Seventeen women participated in focus groups or interviews from July to October 2015 at an Aboriginal and Torres Strait Islander Community-Controlled Health Organisation. Data were analysed with open coding and thematic analysis. The results affirmed Aboriginal women want control over family planning. Participants indicated more could be done to improve health literacy and contraception uptake. A variety of family planning preferences were revealed, with an almost universal desire for increased access to postpartum contraception. Participants wanted information given antenatally and postnatally. Obtaining and using contraception were difficult for many. Social factors that hinder access such as shame, ideas surrounding women's health, cultural disengagement, social isolation and using childbearing to control relationships were identified. The reproductive outcomes of Aboriginal women often do not reflect their preferences. A mandate exists to provide information about and access to postpartum contraception, empowering women with greater control over their reproductive practices. Health professionals can play a key role in dismantling barriers to autonomous family planning by offering information and resources both antenatally and postnatally.

Validation of the Chinese Version of the Australian Breastfeeding Attitude Questionnaire.

BACKGROUND: The Australian Breastfeeding Knowledge and Attitude Questionnaire-Short Form (ABKAQ-SF) was designed to measure breastfeeding knowledge and attitudes of health professionals. To date, a Chinese version of the attitude component of the ABKAQ-SF (ABAQ) is not yet available and has not been cross-validated with nursing students. Research aims: This study aimed to examine (a) the psychometric properties of the ABAQ and (b) group differences and responsiveness of the revised 12-item ABAQ (ABAQ12) among nursing students in Taiwan. METHODS: Using a cross-sectional two-cohort study design, nursing students in Years 2 and 3 of a 4-year bachelor of nursing program ( N = 205) completed the Chinese version of the ABAQ, translated using forward and backward translations. Content validity, internal consistency reliability, construct validity, group differences, and responsiveness of the Chinese version of the ABAQ were assessed. RESULTS: Using the principal axis factoring procedure of exploratory factor analysis to examine the dimensionality of the ABAQ, a one-component structure was identified. Six items were deleted, based on the average interitem correlation (< 0.2), low corrected item-total correlation (< 0.35), and low factor loading (< 0.3). Confirmatory factor analysis of the ABAQ12 supported a one-factor solution, with good overall model fit (goodness-of-fit index = 0.949, Tucker-Lewis index = 0.951, comparative fit index = 0.965, root mean square error of approximation = 0.042). Responsiveness of the ABAQ12 scores indicated a positive change in breastfeeding attitude between the pre- and postclinical placement period. CONCLUSION: The Chinese version of the ABAQ12 is valid, reliable, and responsive and is suitable for assessing the breastfeeding attitudes of nursing students in the Taiwanese higher education settings.

Impact of Maternal Infant Weight Perception on Infant Feeding and Dietary Intake.

Introduction Obesity is a global problem that is challenging to prevent and expensive to treat. Early childhood interventions show promise in establishing lifelong healthy eating patterns, however a better understanding of how parental feeding practices develop is needed. The study aimed to investigate maternal perception of infant weight and its relationship to feeding practices and infant dietary intake. Methods A questionnaire was completed by 263 Queensland mothers of infants aged between 5 and 13 months. Logistic regression was used to describe the association between maternal feeding practices (restriction, pressure-to-eat, monitoring), parenting style (warmth, hostility), infant weight concern and infant dietary intake. Correlation and linear regression were used to identify relationships between maternal feeding practices, parenting style, infant weight concern and infant weight. Results Mothers were found to be more concerned about underweight than overweight, misjudge infants as being underweight and failed to recognise overweight infants. Underweight concern was associated with infant weight (r = -0.27, p < 0.01), early introduction of solids (OR 0.24, CI 0.11-0.51) and pressure-to-eat (r = 0.19, p < 0.01). Pressure-to-eat was associated to maternal perception of infant weight (r = - 0.21, p < 0.01), infant weight (r = - 0.17, p < 0.05) and lower fruit and vegetable intake (OR 0.50, CI 0.27-0.92). Restrictive feeding practices were correlated to overweight concern (r = 0.08, p < 0.05). Discussion Maternal infant weight perception and concerns are related to control feeding practices which can be detrimental to infant dietary intake. Inability to recognise healthy weight may ignite these concerns or fail to address infant feeding risk factors. Discussing healthy growth should be a fundamental component of strategies to support healthy infant feeding and eating.

Navigating motherhood and maternal transitional infant feeding: Learnings for health professionals.

Given the lifelong associations between infant diet and weight, understanding maternal transitional infant feeding decisions can assist efforts to establish healthy eating habits early in life. Feeding experiences were explored using semi-structured interviews with 15 first-time mothers who were selected based on their concerns about their infants' weight in an infant feeding survey. Thematic synthesis of the interview transcripts identified three main themes: (1) Expectations of a "responsible mother", (2) Trusting oneself and trust in others, and (3) From stress to successful feeding. Dominant social ideals of motherhood and infant behaviour influenced feeding practices, some of which are associated with obesity. Judgments of mothers' infant feeding practices and infant size alongside feeding and weight gain 'checklists' undermines maternal transitional feeding knowledge. Family-centred, non-judgmental guidance from peers, family members and health professionals would better support mothers to navigate the day-to-day reality of feeding and caring for an infant throughout the first year of life that is based on achievable personal goals rather than societal ideals.

A feasibility study to improve practice nurses' competence and confidence in providing care for mothers and infants.

BACKGROUND: Postnatal care is best provided in primary health care settings, yet Practice Nurses (PNs) lack relevant training and report difficulty in providing postnatal care. AIM: To evaluate the feasibility of a pilot educational intervention in improving PN competence and confidence to care for mothers and infants in the first postnatal year. DESIGN: A feasibility study. METHODS: PNs were recruited from selected general practices Queensland, Australia to undertake the pilot educational intervention that included a pre-intervention survey, two-day education program, program evaluation and completion of a practice journal. RESULTS: Thirteen PNs from three general practices participated, with 31% completing all study components. Evaluation of the intervention was positive and all participants reported increased confidence and competence in providing postnatal care. Following detailed consideration of feasibility (process, resource, management and scientific assessment) we propose that changes to intervention delivery and data collection should be incorporated into a larger trial.

Women's questions about medicines in pregnancy - An analysis of calls to an Australian national medicines call centre.

BACKGROUND: For many medicines, safe use during pregnancy is not established and adherence is often poor due to safety concerns. Therefore, it is important to identify consumers' medicines information needs during pregnancy. MATERIALS AND METHODS: A retrospective, mixed methods analysis was conducted on eight years of pregnancy-related calls to an Australian national medicines call centre. The call profile of pregnancy and non-pregnancy-related questions were compared. Medicines involved in pregnancy calls were categorised by class (Anatomical Therapeutic Chemical (ATC)3 level), and Therapeutic Goods Administration pregnancy category. Questions in these calls were also themed by pregnancy stage. RESULTS: We identified 4573 pregnancy-related and 118 547 non-pregnancy-related calls. The caller profile for pregnancy-related calls was female (93.7%), asking for herself (83.0%), and while 70.1% of questions involved one medicine, 9.6% involved three or more medicines. Pregnancy enquiries were prompted more often by conflicting information, inadequate information or desire for a second opinion. For 1166 calls, where the stage of pregnancy was available, most questions concerned safety. Medication classified as 'safe' during pregnancy accounted for 34% of these questions. After antidepressants, most calls were made about over-the-counter (OTC) medicines (paracetamol, dexchlorpheniramine, codeine). Safe treatment for everyday conditions was of increasing concern as the pregnancy progressed. CONCLUSION: Pregnant women are concerned about the safety of medication use in pregnancy and a significant proportion overestimate risk. Psychotropic medication and fertility are strong drivers to seek information during preconception. Everyday illnesses and self-medication with OTC medication are a common concern throughout pregnancy, even though many medicines are safe to use.

A qualitative systematic review of maternal infant feeding practices in transitioning from milk feeds to family foods.

Evidence supports the establishment of healthy feeding practices early in life to promote lifelong healthy eating patterns protective against chronic disease such as obesity. Current early childhood obesity prevention interventions are built on extant understandings of how feeding practices relate to infant's cues of hunger and satiety. Further insights regarding factors that influence feeding behaviors in early life may improve program designs and outcomes. Four electronic databases were searched for peer-reviewed qualitative studies published between 2000 to 2014 with transitional infant feeding practice rationale from developed countries. Reporting transparency and potential bias was assessed using the Consolidated Criteria for Reporting Qualitative Research quality checklist. Thematic synthesis of 23 manuscripts identified three themes (and six sub-themes): Theme 1. Infant (physical cues and behavioural cues) focuses on the perceived signs of readiness to start solids and the feeding to influence growth and "health happiness." Theme 2. Mother (coping strategies and knowledge and skills) focuses on the early survival of the infant and the family and the feeding to satisfy hunger and influence infant contentment, and sleep. Theme 3. Community (pressure and inconsistent advice) highlights the importance of generational feeding and how conflicting feeding advice led many mothers to adopt valued familial or culturally established practices. Overall, mothers were pivotal to feeding decisions. Satisfying infant's needs to reach "good mothering" status as measured by societal expectations was highly valued but lacked consideration of nutrition, obesity, and long term health. Maternal interpretation of healthy infant feeding and successful parenting need attention when developing strategies to support new families.

Loss of group memberships predicts depression in postpartum mothers.

PURPOSE: The postpartum period presents the highest risk for women's mental health throughout the lifespan. We aimed to examine the Social Identity Model of Identity Change in this context. More specifically, we investigated changes in social identity during this life transition and their consequences for women's postpartum mental health. METHODS: Women who had given birth within the last 12 months (N = 387) reported on measures of depression, social group memberships, and motherhood identification. RESULTS: Analyses indicated that a decrease in group memberships after having a baby, controlling for group memberships prior to birth, was associated with an increase in depressive symptomology. However, maintaining pre-existing group memberships was predictive of better mental health. New group memberships were not associated with depressive symptomology. Identification as a mother was a strong positive predictor of mental health in the postpartum period. CONCLUSIONS: The social identity model of identity change provides a useful framework for understanding postpartum depression. Interventions to prevent and treat postpartum depression might aim to support women in maintaining important social group networks throughout pregnancy and the postpartum period.

Practice related factors that may impact on postpartum care for mothers and infants in Australian general practice: a cross-sectional survey.

BACKGROUND: While there is a significant focus on the health and well-being of women during pregnancy, labour and birth, much less emphasis is placed on the care of postpartum women and their infants in primary care following the birth. Some studies have investigated the role of GPs in postpartum care, and others examined facilitators and barriers to mothers accessing care. However there is little information available to investigate the effect of practice related factors on access to care of mothers and infants at this time. METHODS: A 20-item questionnaire for completion by the practice managers was mailed to 497 general practices in Southern Queensland, Australia between February and July 2013. Questionnaire items included practice demographics, practice procedures and personnel including appointment scheduling, billing, practice nurse function and qualifications and a free-text option for comments. Descriptive statistics are presented as numbers and percentages. Chi Squared test compared practice location with methods of identification of postpartum women, practice size with other Queensland data and ANOVA compared practice size with the number of postpartum appointments. Logistic regression was used to predict variables that were related to booked appointment times. Free text responses were grouped in common themes. RESULTS: The response rate was 27.4 %. At 67.2 % of the practices, mothers had to self-identify as needing a postpartum consultation and most consultations were allocated 15 minutes or less. Only 20 % of practices accepted the government insurance payment (bulk-billing) for all maternal and infant services, with more practices bulk-billing children only. Out-of-pocket expenses ranged from $10-$60. Nearly 80 % of practice nurses saw postpartum mothers or infants 'nearly always' or 'sometimes'. Approximately 30 % had midwifery or child health training. There were higher odds of longer booked appointment times for solo practitioner practices (unadj OR 3.30 95%CI 1.03-10.57), but no other variables predicted booked appointment times CONCLUSIONS: This study identified a number of practice related factors that, if addressed, could positively impact on postpartum care. These include ensuring ongoing practice relationships to assist with booking appropriate consultation times and guaranteeing that there are no financial impediments to women accessing care. Some factors can easily be adapted within practices. Others would require changes of policy at a local or national level.

ABM Clinical Protocol #20: Engorgement, Revised 2016.

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

How do rural placements affect urban-based Australian junior doctors' perceptions of working in a rural area?

Objectives The aim of the present study was to provide qualitative insights from urban-based junior doctors (graduation to completion of speciality training) of the effect of rural placements and rotations on career aspirations for work in non-metropolitan practices. Methods A qualitative study was performed of junior doctors based in Adelaide, Brisbane and Melbourne. Individual face-to-face or telephone semistructured interviews were held between August and October 2014. Thematic analysis focusing on participants' experience of placements and subsequent attitudes to rural practice was undertaken. Results Most participants undertook rural placements in the first 2 years after graduation. Although experiences varied, positive perceptions of placements were consistently linked with the degree of supervision and professional support provided. These experiences were linked to attitudes about working outside metropolitan areas. Participants expressed concerns about being 'forced' to work in non-metropolitan hospitals in their first postgraduate year; many received little warning of the location or clinical expectations of the placement, causing anxiety and concern. Conclusions Adequate professional support and supervision in rural placements is essential to encourage junior doctors' interests in rural medicine. Having a degree of choice about placements and a positive and supported learning experience increases the likelihood of a positive experience. Doctors open to working outside a metropolitan area should be preferentially allocated an intern position in a non-metropolitan hospital and rotated to more rural locations. What is known about the topic? The maldistribution of the Australian medical workforce has led to the introduction of several initiatives to provide regional and rural experiences for medical students and junior doctors. Although there have been studies outlining the effects of rural background and rural exposure on rural career aspirations, little research has focused on what hinders urban-trained junior doctors from pursuing a rural career. What does this paper add? Exposure to medical practice in regional or rural areas modified and changed the longer-term career aspirations of some junior doctors. Positive experiences increased the openness to and the likelihood of regional or rural practice. However, junior doctors were unlikely to aspire to non-metropolitan practice if they felt they had little control over and were unprepared for a rural placement, had a negative experience or were poorly supported by other clinicians or health services. What are the implications for practitioners? Changes to the process of allocating junior doctors to rural placements so that the doctors felt they had some choice, and ensuring these placements are well supervised and supported, would have a positive impact on junior doctors' attitudes to non-metropolitan practice.

Postpartum consultations in Australian general practice.

Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants.