The State of our Breastfeeding Friendly Childcare Programs: Ten Years After the 2011 Surgeon General's Call to Action to Support Breastfeeding.

BACKGROUND: Ten years ago, the U.S. Surgeon General's Call to Action to Support Breastfeeding made recommendations for childcare settings, including: (1) accommodating and supporting breastfeeding families; and (2) adopting national guidelines on breastfeeding support in childcare settings. RESEARCH AIMS: To (1) describe the existing breastfeeding friendly childcare designation programs in the United States; and (2) describe how states are accommodating breastfeeding families in childcare settings. METHOD: The study design was cross-sectional, prospective thematic description of existing publicly available documents. A search of state breastfeeding coalitions was conducted to assess the number of states with breastfeeding friendly childcare designation programs. A definitive yes-or-no answer regarding whether each state had a program was obtained from all 50 states. For states with programs, designation materials were analyzed using thematic analysis and the framework method to compare designation components. RESULTS: Fifteen states had evidence of breastfeeding friendly childcare designation programs and similarities exist across designation program components. Four standards were common to all 15 programs: written policy on breastfeeding, suitable space within the center where mothers can breastfeed or express their milk, educational materials, and resources on breastfeeding available to parents. Most states required self-assessment to achieve designation status. CONCLUSION: Research is needed to enable evidence-based programs and decision-making regarding components and processes. Federal funding should support these programs' mission, including funding research to assess how and in what circumstances these programs are improving breastfeeding-related outcomes and supporting breastfeeding families.

A Statewide Evaluation of the Breastfeeding Resource Nurse Model.

OBJECTIVE: To evaluate a statewide initiative to increase the provisioning of human milk in NICUs. DESIGN: A survey of nurses before participation in an educational session, immediately after education, and again 9 months later. SETTING: Nurses from 22 hospitals throughout Florida. PARTICIPANTS: We surveyed 121 participants, including some nurses who had prior breastfeeding education or certification as well as those without specialized breastfeeding training. INTERVENTION: An educational project called the Breastfeeding Resource Nurse Master program was intended to educate NICU nurses to implement the "Ten Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants." MEASUREMENT: A quantitative needs assessment survey was administered to participants to determine current hospital practices, policies, and perceived areas for improvement. Pre- and immediate posttraining surveys assessed NICU nurses' knowledge, attitudes, and beliefs about human milk feeding of critical care infants and their self-efficacy for implementing the program in their respective NICUs. A follow-up, open-ended survey was administered at 9 months to yield information on program implementation. RESULTS: NICU breastfeeding practices varied widely at baseline. Nurses' scores for knowledge, beliefs, and behavioral intentions improved postsession, but the implementation of practice changes related to the Ten Steps for Vulnerable Infants proved difficult. Nurses identified insufficient time and resources as barriers to educating others and changing practice. CONCLUSIONS: Policies and regulations that make hospitals accountable for increasing human milk provision to vulnerable infants may be necessary to ensure that hospitals devote adequate resources to implementing practice changes in this area.

Modesty and Security: Attributes Associated with Comfort and Willingness to Engage in Telelactation.

The objectives were to identify conditions under which mothers may be willing to use telelactation and explore associations between participant characteristics, willingness, and beliefs regarding telelactation use. Mothers 2-8 weeks postpartum were recruited from two Florida maternal care sites and surveyed to assess demographics, breastfeeding initiation, and potential telelactation use. Analyses included descriptive statistics and logistic regression models. Of the 88 participants, most were white, married, earned less than USD 50,000 per year, had access to technology, and were willing to use telelactation if it was free (80.7%) or over a secure server (63.6%). Fifty-six percent were willing to use telelactation if it involved feeding the baby without a cover, but only 45.5% were willing if their nipples may be seen. Those with higher odds of willingness to use telelactation under these modesty conditions were experienced using videochat, white, married, and of higher income. Mothers with security concerns had six times the odds of being uncomfortable with telelactation compared to mothers without concerns. While telelactation can improve access to critical services, willingness to use telelactation may depend on conditions of use and sociodemographics. During the COVID-19 pandemic and beyond, these findings offer important insights for lactation professionals implementing virtual consultations.

"Breast Is Best, But " According to Childcare Administrators, Not Best for the Childcare Environment.

Background: Nearly 74% of U.S. mothers work full-time and employment is a cited reason for stopping breastfeeding. In the effort to increase breastfeeding duration, childcare providers could facilitate continuation of human milk feeding when mothers return to work. Yet, mothers report receiving little support when transitioning infants into childcare. Objective: Explore the themes of comfort with human milk and formula feeding among childcare administrators near Tampa, Florida. Material and Methods: Twenty-eight childcare administrators participated in semistructured interviews regarding policies and perceptions about infant feeding practices at their center. Using Applied Thematic Analysis, interview themes were identified. Results: Most administrators agreed "breastfeeding is best." However, they expressed discomfort with mothers breastfeeding at the center and perceived risk with handling and feeding human milk. These perceptions are illustrated through the theme "Formula feeding is normative" and four emergent subthemes: "Human milk is potentially harmful," "People are uncomfortable with breastfeeding in public," "I'm not the expert," and "'Breastfeeding is best', in theory." Conclusion: While breastfeeding may be best for health, from the childcare administrators' perspectives, it may not be best for the childcare environment. A cultural shift may be needed to change norms and perceptions in the childcare environment to support mothers in their effort to provide human milk. Perhaps it is time for a new message, such as "We can help you."

Historical Antecedents of Breastfeeding for African American Women: from the Pre-Colonial Period to the Mid-Twentieth Century.

INTRODUCTION: African American women have much lower breastfeeding rates than other racial and ethnic groups in the USA. While researchers are beginning to explore contemporary factors contributing to this inequality, much less research has been devoted to the historical conditions that have contributed to these disparities. AIM: The aim of this paper was to describe the social, economic, and political factors that have influenced African American breastfeeding behavior in the USA from the colonial era through the mid-twentieth century. METHODS: A thematic analysis was conducted across multiple databases and sources. A social history framework, which focuses on the experiences of ordinary people and events, was used to identify and integrate themes found within the reviewed literature. RESULTS: Three themes emerged: (1) Labor forces and other socio-cultural factors affected feeding practices and communal caregiving; (2) history of supplementation; and (3) influence of medicalization of birth and mobility on infant feeding in the twentieth century. These themes illustrate how African American women's ability to breastfeed has been significantly constrained throughout the U.S. HISTORY: Supplementation with non-human milk substitutes and communal caregiving helped African American women navigate infant rearing under adverse socioeconomic circumstances. CONCLUSIONS: Social, political, and economic factors have contributed significantly to African American women's ability to breastfeed throughout the U.S. HISTORY: Understanding the influences of historical antecedents on breastfeeding decisions over time may be key to finding effective interventions that might increase breastfeeding rates within this population.

"I Didn't Know": Pregnant Women's Oral Health Literacy Experiences and Future Intervention Preferences.

OBJECTIVE: This study explored women's 1) experiences in accessing, understanding, appraising, and applying oral health information and services, and 2) preferences regarding oral health promotion during pregnancy. METHODS: Pregnant women ages 18 to 45 were recruited from an obstetrics and gynecology clinic at a large university hospital. Focus groups were conducted using the four domains of the integrated model of health literacy (access, understand, appraise, apply) and were audio-recorded and professionally transcribed. Thematic analysis was employed using Atlas.ti. RESULTS: Participants (n = 17) were Hispanic (53%), married (67%), college educated (87%), employed (80%), and insured (100%). Most participants reported not accessing or receiving oral health information during pregnancy, with limited information received from less trustworthy sources (Internet; friends/family) and focusing on symptoms or myths. Participants revealed gaps in basic oral health understanding and demonstrated limited ability to evaluate or apply information, such as engaging in positive oral health behaviors, according to their needs and personal health status. Participants strongly desired that oral health promotion be integrated into prenatal care. CONCLUSIONS: Participants described missed opportunities to improve oral health literacy and desire future health messages that facilitate patient-provider communication on oral health during prenatal care visits. Future health interventions should convey the importance and associated risks, be time efficient and patient centered, and include patient activation to prompt oral health-seeking behaviors during pregnancy.