Safety of dermatologic medications in pregnancy and lactation: An Update - Part II: Lactation.

Multiple recently approved medications have been added to our treatment armamentarium for various dermatologic conditions. Herein, we have reviewed the literature, consolidated available safety data, and offered recommendations based upon available evidence as a reference guide for clinicians treating patients for dermatologic conditions during lactation.

A cross-sectional study on the practice of wet nursing among Muslim mothers.

BACKGROUND: Breastfeeding and wet nursing have been synonymous since ancient times. The practice of wet nursing of another woman's child in Malaysia is on the rise due to the emergence of awareness among the public about the importance and advantages of breast milk. However, problems arise when there is no systematic system to record and trace the milk mother and milk child data, especially for Muslim participants as milk kinship could affect their relationship status in Islam. Therefore, this study aims to determine the practice of wet nursing among Muslim mothers in Selangor. Simultaneously, this study intends to provide the authorities with an accurate picture of the more aggressive compilation of steps to prevent duplication of consanguinity in wet nursing. METHODS: This cross-sectional study was conducted on 100 women who had breastfed another child in Selangor. Data were obtained using a validated questionnaire (Cronbach alpha = 0.8) and processed using the SPSS software. RESULTS: Results showed 43.0% of respondents had at least breastfed one someone else's child. Meanwhile, there were 3.0% of the respondents were nursing seven to ten other children. A total of 237 children have been breastfed by the respondents (n = 100). Of these, 21.5% children were breastfed less than five times, while 78.5% children were breastfed less than five times. Most mothers recorded their milk child background data, and this shows that the community is aware of the importance of data documentation and it indirectly proves that the authorities should act on these current needs. CONCLUSIONS: This study shows that there is a wet nursing practice in the society. Obviously, a phenomenon, trend and practice in the society has the ground and basis as to why it existed and is upheld. Researches related to wet nursing and matters connected to it should continue so as to bring about much good to society.

Infant-feeding practices and infant survival by familial wealth in London, 1752-1812.

Anecdotal evidence indicates that high-status women in England generally did not breastfeed their children in the seventeenth and early eighteenth centuries. Metropolitan families of varied social status also often sent their children out of London for wet-nursing. However, anecdotal sources and rural burial registers also suggest that these practices declined rapidly from the mid-eighteenth century, and were replaced by a culture of maternal breastfeeding in all social classes. These changes in infant-feeding practices have been argued to explain much of the dramatic improvement in infant mortality rates in London in this period. Here we used quantitative evidence from a partial family reconstitution of the London parish of St. Martin in the Fields to test these claims. Using birth interval analysis to infer breastfeeding patterns in families by four categories of wealth, we found that birth intervals were close to the national average in pauper and poor families, but much shorter in wealthier families, in the period 1752-74. We also found evidence that many infants especially in wealthier families were missing from observation, consistent with high levels of rural wet-nursing. Both these phenomena declined between 1775 and 1812, suggesting a convergence in breastfeeding practices to the national norm. We used event history analysis, with corrections to aggregate rates for missing infants, to compare mortality rates over time and by wealth category. We found that infant mortality was initially higher in wealthier families, but declined in all groups over the period 1752-1812. We conclude that increases in maternal breastfeeding were probably important in improving survival of infants from wealthier families, however changes in breastfeeding patterns were insufficient to account for the ubiquitous improvements in mortality of urban-born infants in this period.

Facilitators and Barriers of Wet Nursing from Antiquity to the Present: A Narrative Review with Implications for Emergencies.

Background: If maternal breastfeeding is not possible, wet nursing allows infants to receive the nutrition and protection against disease that breastfeeding provides. Such protection may be particularly valuable in emergencies. However, while wet nursing is recommended in the Operational Guidance on Infant and Young Child Feeding in Emergencies it is underutilized. This narrative review aimed to develop an understanding of wet nursing practice across time and location, and why wet nursing is currently so little supported to inform interventions to support wet nursing in emergencies. Method: Medline and Embase were searched for "wet nursing," "cross-nursing," "shared breastfeeding," and "non-maternal nursing". Included articles were inductively analyzed to identify positive and negative factors associated with previous wet nursing practice. Results: This review included 74 records. Our analysis of the wet nursing literature includes historical and contemporary themes with milk kinship and wet nursing as risky being shared themes across time periods. Our analysis revealed that it is how wet nursing is undertaken that influences whether it benefits women, children, and societies or not. Facilitators and barriers to wet nursing in emergencies related to infant mortality rates, cultural and individual support for wet nursing, availability of wet nurses, and resources to support wet nursing. Conclusion: Understanding the conditions under which wet nursing has positive outcomes and what can be done to facilitate beneficial wet nursing practices will assist in enabling wet nursing to be more commonly implemented in emergencies.

Acceptability to donate human milk among postnatal mothers at St. Francis hospital Nsambya, Uganda: a mixed method study.

BACKGROUND: The World Health Organization recommends the use of donated human milk (HM) as the second-best option for mothers who are temporarily unable to provide sufficient breast milk to meet the needs of their infants. However, HM donation is yet to become an accepted practice in Uganda. We assessed the level of, and factors associated with acceptability to donate HM among postnatal mothers at St. Francis Hospital Nsambya (SFHN). METHODS: A cross-sectional sequential explanatory mixed method study was conducted between October 2018 and March 2019. A questionnaire on sociodemography, awareness and likely acceptability to donate HM was administered to 410 postnatal mothers at SFHN. Multivariate logistic regression analysis was undertaken to determine factors associated with acceptance of HM donation. Focus Group Discussions (4) and Key Informants Interviews (4) were used to explore factors influencing behaviours to donate human milk. Qualitative data were analysed using a content thematic approach. RESULTS: Overall acceptance of donating the HM was 77.6%, and the significant factors were: willingness to express the HM (AOR 7.5; 95% CI 3.01, 18.68); wet-nursing knowledge (AOR 2.3; 95% CI 1.1, 5.0) and visit to under-5 years' clinic (AOR 21.3; 95% CI 2.3, 196.9). The major themes in relation to accepting to donate HM were wet nursing experience, and confidence in donating the HM, and its perceived effectiveness. There were concerns about the safety and adequacy of HM and fear of transmitting criminal behaviours and mental illness through human milk. CONCLUSIONS: Acceptance to donate HM among postnatal mothers at St. Francis Hospital Nsambya was very high. Willingness to express and store human milk, prior knowledge about wet nursing and a visit to an under-five outpatient clinic were associated with acceptance. Thus, establishing a human milk bank is feasible in the study setting.

Determining Knowledge and Opinions of Neonatal Intensive Care Unit Nurses on Wet-Nursing and Human Milk Banks: A Cross-Sectional Study in Türkiye.

BACKGROUND: Wet nursing and human milk banks are vital sources of human milk for infants unable to breastfeed. RESEARCH AIM: This study aims to determine the knowledge and opinions of neonatal intensive care unit nurses regarding wet-nursing and human milk banks in Türkiye. METHODS: This descriptive cross-sectional study was conducted with 219 neonatal intensive care unit nurses using an online survey comprising 20 questions. The data were collected between August and September 2021. RESULTS: Among the participants, 64.4% (n = 141) expressed that they would be a wet-nurse and 59.8% (n = 131) would search for a wet-nurse if necessary. Some, 47.0% (n = 103) of participants did not know if there were any human milk banks in Türkiye, 53.9% (n = 118) would like to be a donor if human milk banks were established, and 71.7% (n = 157) stated that the establishment of human milk banks should be supported. Religious concerns were the basis for reluctance to donate milk to human milk banks for 60% (n = 51) of the participants. Knowledge was greater and opinions about wet-nursing and human milk banks were more positive for participants with higher education, more time in the neonatal intensive care unit, or work at a tertiary care center. CONCLUSION: The approaches of neonatal intensive care unit nurses towards personally being wet-nurses and milk sharing were generally positive, although more information about human milk banks is needed. Religious beliefs are an important consideration when providing information about milk sharing.

Neonatal Research at the Archiospedale Santo Spirito in Rome.

Abandoning infants was a heritage of the Roman Empire. Foundling hospitals were established in Italy earlier and in greater number than in other countries; their goal was to prevent infanticides. The Foundling Hospital in Rome, established in the Santo Spirito Church in 1204, paved the way toward modern hospital care and child protection. The Order of the Holy Spirit was appointed by Pope Innocent III to care for foundlings, and set up a network of infant nurseries all over Europe. Poor unmarried pregnant women received obstetric services free of charge. Infants were admitted anonymously by the ruota, a baby hatch or turning wheel. The Order's rule regulated infants' admission, care, nutrition by wet nurses, and boarding out to foster families in the countryside. Chief physicians of the Santo Spirito Hospital were often Sapienza University professors and/or personal physicians to the Popes. Among them were Realdo Colombo, Andrea Caesalpino, Giovanni Lancisi, Giuseppe Flajani, Domenico Morichini, and Tommaso Prelà. They made major scientific progress in anatomy and surgery: descriptions of the pulmonary blood transit, embryonic formation, fetal circulation, malaria transmission from mosquitos, and surgery for congenital malformations such as hydrocephalus, anal atresia, and cleft lip. Per year, 800-1,000 exposed infants were admitted. Despite sufficient funding and meticulous regulation of care and nutrition, mortality in the hospital during the first month of life was around 70%; the causes were neglected surveillance, cleanliness, and artificial nutrition. The institution persisted for more than 700 years due to numerous connections with the Vatican.

Attitudes towards human milk banking among native turkish and refugee women residing in a rural region of Turkey: a mixed-methods approach.

BACKGROUND: Human milk banks (HMB) play an essential role by providing human milk to infants who would otherwise not be able to receive mother's milk. There is currently no donor milk bank in Turkey. For any new health intervention to be successful, determining its acceptability is a vital first step. This study intends to determine the opinions, knowledge, and attitudes of native Turkish and refugee women living in Çestepe, Aydin, a rural area in Turkey, about HMB. METHODS: A population-based cross-sectional, mixed-methods study was conducted. Qualitative study data were collected through in-depth interviews with 33 women, and quantitative study data were collected using a questionnaire. A total of 271 women in the region were included in the study. Qualitative data were thematically analyzed and then a conceptual framework was created. Logistic regression was performed for quantitative data. RESULTS: Fifty-seven point nine per cent of the women were willing to donate breast milk, whereas only 27.7% were willing to use donor milk for their babies. Religious concerns, fear of infectious diseases, and distrust in people they did not know were among the reasons for the negative attitudes of the women. Fear of infectious diseases was mentioned specifically by native Turkish women, and religious concerns were reported both by native Turkish and refugee women. The importance of breast milk and religion were among the reasons for positive attitudes. Additionally, odds of having a positive attitude were 4.19 times higher in homemaker women (95% CI 2.0, 8.76); 4.77 times higher in women with three or more children (95% CI 1.25, 8.15); 6.12 times higher in women who had a positive attitude towards wet nursing (95% CI 3.14, 9.63); and 2.68 times higher in those who had previously heard about human milk banking (95% CI 1.24, 5.79). CONCLUSION: Attitudes towards HMB are affected by religion, cultural beliefs, and concerns about the safety of breast milk in HMBs. Refugees and native Turkish women are found to have similar religious concerns. These findings should be taken into consideration in human milk banking initiatives and in activities to increase acceptance by the public.

Historical Research: Conditions of Boarded Out Babies of Wet-Nurses, Colonial Australia.

Wet-nurses themselves rarely left written accounts. In this article, I have reconstructed their experiences and work situations breastfeeding other women's infants in colonial Australia through examining available sources concerning their employment situations and the fate of their infants when they were boarded out, as they commonly were. The employment of wet-nurses by royal households or prominent families has long been the topic of historical accounts, whereas the situation of the more numerous wet-nurses further down the social spectrum has received disproportionately little examination. In this article, I do not discuss informal, altruistic wet nursing by family or neighbors but, rather, the situation of those women for whom it was an occupation, by its very nature short term. Primary material sighted for this study included a considerable number of advertisements for positions placed by employers, their intermediaries (e.g., family physicians) and wet-nurses themselves, and newspaper reports when the wet-nurse's children came to the attention of the courts. Death for boarded-out infants who succumbed to inappropriate feeding and substandard care was typically ascribed to "natural causes."

DOES IT HAPPEN THAT A WOMAN DOES NOT BREASTFEED A CHILD BY HERSELF? THEN WHO IS BREASTFEEDING A CHILD? ETHNOGRAPHIC ACCOUNTS FROM THE ZBORNIK ZA NARODNI ZIVOT I OBICAJE JUZNIH SLAVENA (JOURNAL OF FOLK LIFE AND TRADITIONS OF SOUTH SLAVS) / DOGODI LI SE, DA ZENA SAMA NE DOJI DJETETA? TKO GA ONDA DOJI? ETNOGRAFSKI ZAPISI IZ ZBORNIKA ZA NARODNI ZIVOT I OBICAJE JUZNIH SLAVENA

Based on a reading of the ethnographic accounts that were written in accordance with the Osnova za sabiranje i proucavanje grade o narodnom zivotu (Foundations for Collecting and Studying Materials about Folk Life) published in 1897, this paper attempts to outline some of the features of wet-nursing as specific breastfeeding related practices in rural areas at the turn of the 19th to the 20th century. Ethnographic accounts published in the Zbornik za narodni zivot i obicaje juznih Slavena ( Journal of Folk Life and Traditions of South Slavs) that are, with some retrospective insights, mainly focused on what were then contemporary practices, are approached in this paper as sources of the ethnology and the history of everyday life. Through connecting passages on breastfeeding and also passages that refer indirectly to breastfeeding, this paper underlines the importance of differentiation between the practices of regular wet-nursing (caused by a mother's illness or her problems with breastfeeding) and occasional wet-nursing (because of a mother's temporary, short-term absence). This paper also deals with the issue of (material) compensation for wet-nursing and, connected to this, with the relation between women's efforts to earn an income on the one hand and women's solidarity on the other. It also deals with the issue of the professionalization of wet-nursing that is not covered in the questions from Osnova (Foundations for Collecting and Studying Materials about Folk Life) and is only indicated in ethnographic accounts from the Zbornik (Journal of Folk Life and Traditions of South Slavs).

Reproductive strategies and sex-biased investment : Suggested roles of breast-feeding and wet-nursing.

Sex-biased investment in children has been explored in a historic population in northern England, 1600 to 1800, following a family reconstitution study. An examination of the wills and other available data identified three social groups: the elite, tradesmen, and subsistence farmers. The community lived under marginal conditions with poor and fluctuating levels of nutrition; infant and child mortalities were high. Clear differences were found between the social groups, and it is suggested that the elite wetnursed their daughters whereas the elite mother breast-fed her sons for only a short period and introduced supplementary feeding early. The wives of the tradesmen probably breast-fed both sexes for the same length of time. Subsistence farmers may have weaned their sons earlier than daughters. The results are discussed in terms of possible differences in investment strategies. The investment strategy of the elite group was probably male-biased but may, in practice, have favored the female offspring.

Peer-to-peer milk donors' and recipients' experiences and perceptions of donor milk banks.

OBJECTIVE: To explore the intersection of peer-to-peer milk sharing and donor milk banks. METHODS: A descriptive survey design containing closed and open-ended questions was used to examine women's perceptions of peer-to-peer milk sharing and milk banking. Closed-ended questions were analyzed using descriptive statistics and conventional qualitative content analysis was used to analyze open-ended responses. SETTING: Participants were recruited via the Facebook sites of two online milk-sharing networks (Human Milk 4 Human Babies and Eats on Feet). PARTICIPANTS: Ninety-eight milk donors and 41 milk recipients who had donated or received breast milk in an arrangement that was facilitated via the Internet. RESULTS: One half of donor recipients could not donate to a milk bank because there were no banks local to them or they did not qualify as donors. Other respondents did not donate to a milk bank because they viewed the process as difficult, had philosophical objections to milk banking, or had a philosophical attraction to peer sharing. Most donor respondents felt it was important to know the circumstances of their milk recipients. No recipient respondents had obtained milk from a milk bank; it was recognized that they would not qualify for banked milk or that banked milk was cost prohibitive. CONCLUSION: Peer-to-peer milk donors and recipients may differ from milk bank donors and recipients in significant ways. Cooperation between milk banks and peer sharing networks could benefit both groups.

Milk sharing and formula feeding: Infant feeding risks in comparative perspective?

The advent of Internet forums that facilitate peer-to-peer human milk sharing has resulted in health authorities stating that sharing human milk is dangerous. There are risks associated with all forms of infant feeding, including breastfeeding and the use of manufactured infant formulas. However, health authorities do not warn against using formula or breastfeeding; they provide guidance on how to manage risk. Cultural distaste for sharing human milk, not evidenced-based research, supports these official warnings. Regulating bodies should conduct research and disseminate information about how to mitigate possible risks of sharing human milk, rather than proscribe the practice outright.

From folklore to scientific evidence: breast-feeding and wet-nursing in islam and the case of non-puerperal lactation.

Breast-feeding practice has an important medical and socio-cultural role. It has many anthropological aspects concerning the "power structures" that find their expression in breast-feeding and the practices that formed around it, both socially, scientifically, and legally-speaking. Breast-feeding has been given much attention by religions and taboos, folklore, and misconception abound around it making it a topic of genuine curiosity. This paper aims at expanding the spectrum of folklore associated with breast-feeding. The paper deals with historical, religious, and folkloristic aspects of breast-feeding, especially wet-nursing, in Islam and focuses on an intriguing Islamic tale on breast-feeding - lactation by non-pregnant women (or non-puerperal lactation). Apparently, accounts of non-puerperal lactation are not restricted to Islam but have been documented in various societies and religions throughout centuries. Two medical situations - hyperprolactinemia and induced lactation, appear as possible explanations for this phenomenon. This serves as an excellent example for the value of utilizing contemporary scientific knowledge in order to elucidate the origin, anthropology and evolvement of ancient myth and superstition.