Theoretical approaches in the development of interventions to promote breastfeeding: A scoping review.

PROBLEM AND BACKGROUND: There is a low world rate of exclusive breastfeeding and a short duration of breastfeeding. More studies have constructed interventions to improve breastfeeding behavior, but the actual effect is not significant. AIM: The purpose of this review is identifying the ways that various theories have an influence on theory-based breastfeeding intervention studies. METHODS: A scoping review using Arksey and O'Malley's framework explored breastfeeding promotion practices. PubMed, The Cochrane Library, Web of Science, Embase, and CINAHL databases were searched from database creation to March 9, 2024. Building on previous research, key terms were used to search the literature. Data analysis involved descriptive and interpretive summaries of theories used and the proposed interventions. FINDINGS: An online search yielded 906 articles, with 28 meeting the inclusion criteria for the scoping review, including 5 reviews and 23 articles. Reviews demonstrated that interventions based on theories were more effective. Articles promoting breastfeeding used theories of self-efficacy (n = 9), theory of planned behavior (n = 8), social cognitive theory (n = 5) and individual and family self-management theory (n = 1). These theories were used in developing specific content of the intervention program (n = 20, 86.9%), constructing the framework of the program (n = 10, 43.5%), and evaluating outcomes (n = 19, 82.6%). Most interventions focused on education, professional support, and/or peer support for breastfeeding. CONCLUSION AND DISCUSSION: Theory can guide decisions and play a role in selecting a methodology or lens. Researchers should make deliberate choices in the use of a theory that relates to aspects of breastfeeding behavior. Future interventions based on theories should be more varied and effective and need to consider families' and social factors.

Community infant safe sleep and breastfeeding promotion and population level-outcomes: A mixed methods study.

PROBLEM: In the U.S., sudden unexpected infant deaths due to accidental suffocation and strangulation in bed are increasing. Though breastfeeding is a protective factor against sudden unexpected infant death, motivations to breastfeed often couple with unsafe infant sleep practices. Racial/ethnic disparities are present in sudden unexpected infant death, accidental suffocation and strangulation in bed, and breastfeeding. BACKGROUND: Promoting infant safe sleep and breastfeeding through community-level initiatives could address disparities in related outcomes. AIM: Investigate the relationship between community-level strategies and associated state-level outcomes for infant safe sleep and breastfeeding. METHODS: We employed an intervention mixed methods framework and exploratory sequential design. The qualitative component entailed a hermeneutical phenomenological framework to analyze key informant interview data from seven U.S. community-level providers participating in a practice improvement initiative. The quantitative component entailed descriptively analyzing infant safe sleep and breastfeeding indicators from the 2019 Pregnancy Risk Assessment Monitoring System and Ohio Pregnancy Assessment Survey. Qualitative and quantitative data were linked through embedded integration. FINDINGS: We identified two mixed insights: gaps in promotion and outcomes, and persistent disparities between infant safe sleep and breastfeeding promotion and outcomes. DISCUSSION: Our findings indicate conversational approaches could improve infant safe sleep and breastfeeding promotion, outcomes, and relative disparities. We find that community collaboration is needed to address organizational capacity limitations in promoting infant safe sleep and breastfeeding. CONCLUSION: Community-level organizations and providers should consider tailoring program offerings and care delivery to include conversational approaches and community collaboration to promote infant safe sleep and breastfeeding and decrease relative disparities in outcomes.

Fathers' needs of breastfeeding support: Perspective of health nurses.

PURPOSE: To explore the improvement of health education on father's participation in breastfeeding from the perspective of maternal and child health nurses. METHODS: Qualitative phenomenological research was used, and 15 maternal and child health nurses who provided breastfeeding support were invited. With semi-structured deep interviews and on-site recordings, data were analyzed through content analysis. RESULTS: Four main themes were extracted, including 'cultivating fathers' awareness of participation in breastfeeding', 'collaboration of multiple disciplines to improve health education on breastfeeding for fathers in hospital', 'Simulated scenarios to develop fathers' skills in solving breastfeeding problems', and 'establishing a hospital-community interface network to improve breastfeeding continuation care after hospital discharge'. CONCLUSIONS: Medical and health care departments should attach importance to guidance on health education for fathers' breastfeeding participation, cultivate fathers' awareness of participation in breastfeeding, provide multi-disciplinary collaboration-based health education on breastfeeding for fathers from the prenatal period and improve post-discharge health education on breastfeeding. The additional education being suggested would contribute to fathers being able to play an important role in breastfeeding.

Premarket Notifications and Patents for Breast Pumps Before and After the ACA.

This study investigates whether ACA policies to increase access to breast pumps and lactation care were associated with innovation in the market for breast pumps.

Comparative Assessment of Exclusive Breastfeeding Rates From 24-Hour Recall and Since Birth Methods in Southwestern Pennsylvania Using Ecological Momentary Assessment.

BACKGROUND: Accurate measurement of exclusive breastfeeding is important in maternal and child health research. Exclusive breastfeeding is often measured using the 24-hour recall or the since birth method for the first 6 months. These methods can produce different estimates, introducing problems in interpreting breastfeeding behavior and making accurate comparisons across settings or countries. RESEARCH AIM: Our aim was to compare the exclusive breastfeeding rates between the 24-hour recall and since birth methods among a diverse cohort of birthing people using the ecological momentary assessments method. In addition, we compared the exclusive breastfeeding rates between the two methods across race and other maternal characteristics. METHODS: This study is a secondary analysis using data from the Postpartum Mothers Mobile Study (PMOMS), a prospective longitudinal study which recruited participants during pregnancy and followed them for 12 months after delivery. Participants completed surveys in real-time via ecological momentary assessment. Individual exclusive breastfeeding rates from months 1-6 were computed using 24-hour recall and since birth methods for 284 participants. We calculated the percentage point difference between the two methods across child age and maternal characteristics. We used a two-sample test of proportions to determine if the differences observed in the proportions were significant. RESULTS: Exclusive breastfeeding rates from the 24-hour recall were higher than the since birth rates across all ages and maternal characteristics. The difference between the two methods at 3 months was 25.7 percentage points and at 6 months was a 17.2 percentage points. Irrespective of the method used to measure exclusive breastfeeding, White participants had higher exclusive breastfeeding rates than Black participants. CONCLUSION: The 24-hour recall and the since birth methods of assessing exclusive breastfeeding provided substantially different estimates. These findings highlight the importance of specificity in measuring and reporting exclusive breastfeeding.

Comparing Experiences of Women Who Were Direct Breastfeeding and Women Who Used Expressed Breast Milk to Feed Their Infants.

PURPOSE: To provide understanding about feeding experiences of women who provide breast milk through direct breastfeeding and exclusive expression and to compare these experiences. STUDY DESIGN AND METHODS: A qualitative study was conducted to gather experiences from the perspectives of women who had given birth to a healthy, term infant within the past 12 months and exclusively fed breast milk for at least 2 weeks. The sample was recruited from motherhood and breastfeeding support groups on Facebook. Groups had state- or national-based memberships. Interviews were examined for themes that were compared between feeding groups using thematic analysis. RESULTS: Fifteen new mothers participated. Under the primary themes of Similarities and Differences, seven subthemes were identified: Fatigue, Importance of Support, Finding Joy in a Common Goal, Mixed Feelings, Trusting versus Tracking, Latching versus Body Failure, and Pumping in Isolation. CLINICAL IMPLICATIONS: Mothers who provide breast milk share common experiences and feelings of satisfaction. Expressed breast milk feeding offers some mothers a way to provide the benefits of breast milk while preserving a balance between maternal and infant physical and mental health needs. Understanding the different ways in which women manage breast milk feeding while balancing maternal and infant needs can prepare nurses to discuss various methods of breast milk feeding and provide individualized support.

Translation to Spanish and validation of a scale for the observation of breastfeeding: The Bristol Breastfeeding Assessment Tool.

INTRODUCTION: The observation of a feeding by a professional is important to strengthen breastfeeding. The Bristol Breastfeeding Assessment Tool (BBAT) was translated into Spanish and validated. MATERIAL AND METHODS: Translation and back-translation of the original scale was done. Six pediatricians and six pediatric nurses collaborated. At the newborn's first visit, a feeding was observed and the pediatrician and nurse scored the BBAT scale independently. The nurse also scored the LATCH Breastfeeding Assessment (LATCH) and each mother filled out the Breastfeeding Self-Efficacy Scale (BSES-SF). Mothers were appointed a week later and the nurse re-scored the BBAT. RESULTS: A total of 62 mothers participated. There was good internal consisitency for the BBAT (Cronbach's alpha = 0.83 in the assessment made by the nurses and Cronbach's alpha = 0.79 in the assessment made by the pediatricians). Inter-rater consistency showed an intra-class correlation coefficient of 0.91, while for the test-retest was 0.67. Concurrent validity with the BSES-SF scale was good and with the LATCH scale very good. The factor analysis showed the one-dimensional character of the scale and a good homogeneity of the 4 items (positioning = 0.771, attachment = 0.852, sucking = 0.856 and swallowing = 0.679). CONCLUSIONS: The scale obtained in Spanish shows good reliability and validity. The BBAT is an easy-to-use tool that allows breastfeeding assessment and determines the aspects that need to be improved.

Study protocol for reducing disparity in receipt of mother's own milk in very low birth weight infants (ReDiMOM): a randomized trial to improve adherence to sustained maternal breast pump use.

BACKGROUND: Black very low birth weight (VLBW; < 1500 g birth weight) and very preterm (VP, < 32 weeks gestational age, inclusive of extremely preterm, < 28 weeks gestational age) infants are significantly less likely than other VLBW and VP infants to receive mother's own milk (MOM) through to discharge from the neonatal intensive care unit (NICU). The costs associated with adhering to pumping maternal breast milk are borne by mothers and contribute to this disparity. This randomized controlled trial tests the effectiveness and cost-effectiveness of an intervention to offset maternal costs associated with pumping. METHODS: This randomized control trial will enroll 284 mothers and their VP infants to test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to breast pump use by offsetting maternal costs that serve as barriers to sustaining MOM feedings and the receipt of MOM at NICU discharge. Compared to current standard of care (mother provides MOM), the intervention bundle includes three components: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs. The primary outcome is infant receipt of MOM at the time of NICU discharge, and secondary outcomes include infant receipt of any MOM during the NICU hospitalization, duration of MOM feedings (days), and cumulative dose of MOM feedings (total mL/kg of MOM) received by the infant during the NICU hospitalization; maternal duration of MOM pumping (days) and volume of MOM pumped (mLs); and total cost of NICU care. Additionally, we will compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available and the cost-effectiveness of the intervention (NICU acquires MOM) versus standard of care (mother provides MOM). DISCUSSION: This trial will determine the effectiveness of an economic intervention that transfers the costs of feeding VLBWand VP infants from mothers to the NICU to address the disparity in the receipt of MOM feedings at NICU discharge by Black infants. The cost-effectiveness analysis will provide data that inform the adoption and scalability of this intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04540575 , registered September 7, 2020.

LATCH como ferramenta sistematizada para avaliação da técnica de amamentação na maternidade / LATCH como herramienta sistematizada para evaluar la técnica de lactancia en la maternidad / LATCH as a systematic tool for assessment of the breastfeeding technique in maternity

Resumo Objetivo Analisar as dificuldades das mulheres relacionadas à técnica de amamentação, segundo a escala LATCH e verificar relações com as características sociodemográficas, obstétricas e neonatais. Métodos Estudo analítico transversal com mulheres e respectivos filhos únicos em aleitamento materno exclusivo entre junho e dezembro de 2015. Os escores individuais e total da escala LATCH foram usados para avaliar a técnica de amamentação, considerando-se as dificuldades das mulheres para amamentar e as horas de vida da criança. Os testes Qui-quadrado, exato de Fisher, Kruskal-Wallis e um modelo linear generalizado foram usados para avaliar as relações entre os escores da LATCH e as características sociodemográficas, clínicas e obstétricas. Resultados Dentre as 162 duplas mãe-filho analisadas, as crianças com mais 48 horas de vida apresentaram menos dificuldades em relação à pega (p=0,002), à deglutição audível (p<0,001) e ao posicionamento (p<0,001). No item conforto, as puérperas com filhos com <24 horas de vida apresentaram menos dor (p=0,004). O LATCH foi menor para as mulheres com cirurgia mamária prévia (p=0,005), com filhos prematuros (p=0,011), peso menor de 2.500 gramas (p=0,006) e com <24 horas de vida. Conclusão O uso do LATCH foi útil na análise das dificuldades da técnica de amamentação das mulheres durante a fase da internação, considerando as características da mulher e da criança.

Resumen Objetivo Analizar las dificultades de las mujeres relacionadas con la técnica de lactancia, de acuerdo con la escala LATCH y verificar relaciones con características sociodemográficas, obstétricas y neonatales. Métodos Estudio analítico transversal con mujeres y sus respectivos hijos únicos en lactancia materna exclusiva entre julio y diciembre de 2015. La puntuación individual y total de la escala LATCH fue utilizada para evaluar la técnica de lactancia, considerando las dificultades de las mujeres para amamantar y las horas de vida del bebé. Para evaluar las relaciones entre la puntuación de LATCH y las características sociodemográficas, clínicas y obstétricas, se utilizó la prueba χ2 de Pearson, la prueba exacta de Fisher, la prueba de Kruskal-Wallis y un modelo lineal generalizado. Resultados Entre los 162 binomios madre e hijo analizados, los niños con más de 48 horas de vida presentaron menos dificultades con relación a la prendida (p=0,002), a la deglución audible (p<0,001) y a la colocación (p<0,001). En el área comodidad, las puérperas con hijos de <24 horas de vida presentaron menor dolor (p=0,004). La puntuación LATCH fue menor en mujeres con cirugía mamaria previa (p=0,005), con hijos prematuros (p=0,011), peso inferior a 2500 gramos (p=0,006) y con <24 horas de vida. Conclusión El uso de la escala LATCH fue útil para analizar las dificultades de la técnica de lactancia de mujeres durante la fase de internación, considerando las características de la mujer y del niño.

Abstract Objective To analyze women's difficulties related to the breastfeeding technique according to the LATCH tool and assess the relationships with sociodemographic, obstetric and neonatal characteristics. Methods Cross-sectional analytical study with women in a single birth and their children in exclusive breastfeeding between June and December 2015. The individual and total scores of the LATCH tool were used to assess the breastfeeding technique, considering women's difficulties to breastfeed and the child's hours of life. Chi-square, Fisher's exact, Kruskal-Wallis tests, and a generalized linear model were used to assess the relationships between LATCH scores and sociodemographic, clinical, and obstetric characteristics. Results Among the 162 mother-child pairs analyzed, children over 48 hours of life presented less difficulties in relation to latching (p=0.002), audible swallowing (p<0.001) and positioning (p<0.001). In the comfort item, women with infants <24 hours of life had less painful (p=0.004). The LATCH score was lower for women with previous breast surgery (p=0.005), with premature children (p=0.011) weighing less than 2,500 grams (p=0.006) and aged <24 hours of life. Conclusion The LATCH tool was useful in analyzing women's difficulties with the breastfeeding technique during the hospitalization phase, considering the characteristics of the woman and the child.

Assessment of breastfeeding techniques in Enugu, South-East Nigeria.

Background: Good breastfeeding technique is important in ensuring adequate milk delivery and preventing breastfeeding problems. Exclusive breastfeeding rate is quite low, and requisite skills regarding proper positioning and attachment of an infant while breastfeeding appears lacking among mothers in Nigeria. This study was undertaken to assess breastfeeding techniques of mothers attending the well-child clinics of two tertiary hospitals in southeast Nigeria. Materials and Methods: This cross-sectional descriptive study of 396 mother and child pairs who attend the well child clinics of two tertiary hospitals in Enugu (Enugu state University Teaching Hospital and University of Nigeria Teaching Hospital) between September 2018 and February 2019. An interviewer administered, well-structured pro forma was used to collect data while mothers were observed closely as they breastfed and scored using the World Health Organization criteria. Data were analyzed using SPSS version 22. Results: Most of the mothers studied (357; 90.2%) attended ante-natal care, and 365 (92.2%) of the deliveries were assisted by a health worker. Only 194 (49%) of mothers practiced good breastfeeding techniques. Maternal age (20-30 years) (P < 0.001, odds ratio [OR] 0.464), attendance to antenatal clinic (P < 0.001; OR 8.336), health education and demonstration on breastfeeding techniques before and after delivery (P = 0.001) and maternal level of education (χ2 = 13.173, P = 0.001) but not parity (P = 0.386; OR 1.192) were significantly associated with good breastfeeding techniques. Conclusion: There are suboptimal breastfeeding techniques among mothers. Increased awareness creation and regular demonstration of breastfeeding techniques are needed.

RésuméContexte: Une bonne technique d'allaitement est importante pour assurer une livraison adéquate du lait et prévenir les problèmes d'allaitement. Exclusive le taux d'allaitement est assez faible, et les compétences requises en ce qui concerne le positionnement et l'attachement appropriés d'un nourrisson pendant l'allaitement semblent manqué chez les mères au Nigéria. Cette étude a été entreprise pour évaluer les techniques d'allaitement des mères qui fréquentent les cliniques hôpitaux tertiaires dans le sud-est du Nigeria. Matériaux et méthodes: Cette étude descriptive transversale de 396 couples de mères et d'enfants assister aux cliniques pour enfants de deux hôpitaux tertiaires à Enugu (Hôpital universitaire d'Enseignement de l'Université d'Enugu et Université du Nigeria Enseignement hôpital) entre septembre 2018 et février 2019. Un intervieweur administré, bien structuré pro forma a été utilisé pour recueillir des données les mères ont été observées de près au fur et à mesure qu'elles allaitaient et scorelaient selon les critères de l'Organisation mondiale de la santé. Les données ont été analysées à l'aide du SPSS version 22. Résultats: La plupart des mères étudiées (357; 90,2 %) soins prénatals, et 365 (92,2 %) des livraisons ont été assistées par un travailleur de la santé. Seulement 194 (49%) des mères pratiquaient de bonnes techniques d'allaitement. Âge maternel (20­30 ans) (P 0,001, rapport de cotes [OR] 0.464), présence à la clinique prénatale (P 0,001; OU 8.336), éducation à la santé et démonstration sur les techniques d'allaitement avant et après (P = 0,001) et le niveau d'éducation maternel (2 = 13,173, P = 0,001) mais pas la parité (P = 0,386; OR 1.192) ont été significativement associés avec de bonnes techniques d'allaitement. Conclusion: Il existe des techniques d'allaitement sous-optimales chez les mères. Création accrue de sensibilisation et une démonstration régulière des techniques d'allaitement sont nécessaires.

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals.

OBJECTIVE: There is a paucity of evidence to guide the clinical care of late preterm and term neonates born to women with perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The objective of this case series is to describe early neonatal outcomes and inpatient management in U.S. hospitals. STUDY DESIGN: We solicited cases of mother-infant dyads affected by novel coronavirus disease 2019 (COVID-19) from the Better Outcomes through Research for Newborns (BORN) Network members. Using a structured case template, participating sites contributed deidentified, retrospective birth hospitalization data for neonates ≥35 weeks of gestation at birth with mothers who tested positive for SARS-CoV-2 before delivery. We describe demographic and clinical characteristics, clinical management, and neonatal outcomes. RESULTS: Sixteen U.S. hospitals contributed 70 cases. Birth hospitalizations were uncomplicated for 66 (94%) neonates in which 4 (6%) required admission to a neonatal intensive care unit. None required evaluation or treatment for infection, and all who were tested for SARS-CoV-2 were negative (n = 57). Half of the dyads were colocated (n = 34) and 40% directly breastfed (n = 28). Outpatient follow-up data were available for 13 neonates, all of whom remained asymptomatic. CONCLUSION: In this multisite case series of 70 neonates born to women with SARS-CoV-2 infection, clinical outcomes were overall good, and there were no documented neonatal SARS-CoV-2 infections. Clinical management was largely inconsistent with contemporaneous U.S. COVID-19 guidelines for nursery care, suggesting concerns about the acceptability and feasibility of those recommendations. Longitudinal studies are urgently needed to assess the benefits and harms of current practices to inform evidence-based clinical care and aid shared decision-making. KEY POINTS: · Birth hospitalizations were uncomplicated for late preterm and term infants with maternal COVID-19.. · Nursery management of dyads affected by COVID-19 varied between hospitals.. · Adherence to contemporaneous U.S. clinical guidelines for nursery care was low.. · Breastfeeding rates were lower for dyads roomed separately than those who were colocated..

Colostrum avoidance practice among primipara mothers in urban Northwest Ethiopia. A cross-sectional study.

BACKGROUND: Breast milk is the ideal and complete form of nutrition for infants colostrum contains all the necessary nutrients for infants' growth and development and antibodies that can protect from many childhood illnesses. Understanding the extent of and barriers to colostrum avoidance in Ethiopia is important for learning how to best improve optimal breastfeeding. No single study has been conducted on primigavida mothers in the country. Therefore, this study aimed to assess the rate of colostrum avoidance practice and associated factors among primigavida mothers. METHOD: A community- based cross-sectional study was conducted from March to April 2016 among (n = 398) randomly selected primigavida mothers in Bahir Dar city, northwest Ethiopia. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version25. Bivariate and multivariate logistic regression analyses were carried out. Odds ratio with 95% confidence interval was used to measure the strength of association. Statistical significance was declared at P-value ≤0.05. RESULTS: Out of 398 primipara mothers, 8.8% discarded colostrum. The most common reasons for discarding colostrum were; yellow and creamy (39.2%), bad for infant (35.2%), traditional/cultural reason (17.1%) and infant unable to feed (8.5%). Married mothers (AOR = 4.52, 95%CI: 1.13, 18.16), unemployed mothers (AOR = 3.46, 95%CI: 1.15, 10.51), mothers underwent normal delivery (AOR = 5.20, 95%CI: 1.87, 20.90) and mothers who initiated breastfeeding within 1 h (AOR = 2.79, 95%CI: 0.96, 8.16) were less likely to discard colostrum. CONCLUSION: The current study revealed that colostrum was discarded by 8.8% of primipara mothers. Primipara mothers who were married, unemployed, underwent normal delivery and initiated breastfeeding within 1 h were less likely to discard colostrum. These results suggest that multi-sectorial and multi-disciplinary approaches are needed to decrease colostrum avoidance among primipara mothers in Ethiopia.

The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio.

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

Informal Milk Sharing for the Hospitalized at-Risk Infant in the Ultra-Orthodox-Haredi Jewish Community in the United States.

The process of human milk donation and sharing for the promotion of infant health is a phenomenon of interest as it directly affects children's health and well-being. Although its prevalence is currently unknown, informal sharing of human milk is occurring across the United States. The U.S. Food and Drug Administration recommends against informal sharing of human milk. However, the Ultra-Orthodox (Haredi) Orthodox Jewish population, who strictly observes Jewish laws and often consults with rabbis before making medical decisions, is known to donate and obtain milk through informal sharing. The objective of this study was to explore the lived experience of informal donation from the perspective of Ultra-Orthodox mothers from the Northeastern region of the United States who engaged in milk sharing to support hospitalized at-risk infants. Women were interviewed by an Orthodox Jewish member of the team, using a semistructured interview guide. Informal milk sharing was regarded as a positive empowering experience. Themes which illuminate the phenomena of milk sharing include faith, mistrust of the medical establishment, a strong reliance on social connectedness, and importance of sacred cultural traditions. Health care providers need to be aware of these specific needs to provide culturally sensitive care for safer milk sharing practices in cloistered and faith-based communities.

Home-based newborn care voucher initiative in Assam: An evaluation.

BACKGROUND: An innovative home-based newborn care (HBNC) voucher system has been introduced in Assam to improve home visits of accredited social health activists (ASHAs), make them more accountable, and empower the community. OBJECTIVE: This study aimed to evaluate the effectiveness of HBNC voucher initiative in Assam. METHODS: A mixed methodology study was conducted in 2018 including 4 districts of Assam. A quantitative study was done among a sample of 836 lactating mothers by interviewing them through house-to-house visits. A qualitative study was done by in-depth interview of various health-care service providers. RESULTS: Of 836 lactating mothers, 65% received HBNC voucher; 45.6% received at the time of discharge, and 5.3% during antenatal care. The purpose of HBNC vouchers as a tool of validating ASHAs' home visits was explained to only 14.5% of lactating mothers. Examination of newborn (44.6%), counseling on breastfeeding (57.1%), counseling on care of baby (39.2%), and counseling on immunization (49.2%) were the services commonly provided by ASHA during HBNC visits. Voucher system improved incentive payment system, but uninterrupted supply was a problem area as stated by ASHAs. Auxiliary nurse midwives and ASHA supervisors told that voucher system had improved ASHA home visits, payment system, and increased identification of danger signs of newborns. CONCLUSIONS: HBNC voucher system as an innovative approach was found to be effective. Coverage of services varied among different districts. Uninterrupted supply of the vouchers, periodic resensitization of health workers on its use, and increasing awareness among the community is needed to be sustained.

Outcomes of pregnancy in women with cystic fibrosis (CF) taking CFTR modulators - an international survey.

BACKGROUND: As their long-term prognosis improves, women with CF are increasingly choosing to have children, but the safety of CFTR modulators in pregnancy and breastfeeding is currently unknown. METHODS: A survey was sent to lead clinicians of adult CF centres in Europe, the United Kingdom (UK), United States of America (USA), Australia and Israel requesting anonymised data on pregnancy outcomes in women using CFTR modulators before and during pregnancy and lactation. RESULTS: We identified 64 pregnancies in 61 women taking IVA (n = 31), LUM/IVA (n = 26) or TEZ/IVA (n = 7), resulting in 60 live births. In 44 pregnancies, CFTR modulators were either continued throughout pregnancy or temporarily stopped and then restarted. Two maternal complications were deemed related to CFTR modulator therapy; cessation of modulator therapy resulted in clinical decline in 9 women prompting resumption of therapy during pregnancy. No modulator-related complications were reported in infants exposed in utero and/or during breastfeeding. CONCLUSIONS: CFTR modulators were reported to be generally well tolerated in pregnancy and breastfeeding, with only 2 maternal complications that were deemed related to CFTR modulator therapy. Women stopping CFTR modulators in pregnancy may experience a decline in clinical status and in the cases identified in this survey, restarting therapy led to a clinical improvement. Current experience remains limited and longer-term prospective follow-up is required to exclude delayed adverse effects.

Structural vulnerabilities and breastfeeding among female sex workers in Mumbai.

Breastfeeding has numerous health, environmental, and economic benefits, and the promotion and support of breastfeeding has been at the centre of efforts from many global organizations such as WHO and UNICEF to promote maternal and child health. Interventions developed from such policies tend to be inaccessible to those who are economically marginalized, however, and thus may further inequities. Understanding the lived experiences of women occupying this segment of society, such as sex workers, illuminates the social and structural determinants of breastfeeding and how they constitute structural vulnerability that renders breastfeeding difficult. This qualitative study explores breastfeeding practices and decisions among sex workers in Mumbai and the factors shaping their experiences. We look at proximal factors-those that women directly indicate as influencing their breastfeeding decision-making or behaviour, and distal factors-macrolevel forces identified by the women, as indication of their structural vulnerability, particularly in relationship to the decision to initiate and sustain breastfeeding. We conclude with discussing the need to promote appropriate infant feeding practices through culturally responsive interventions and mechanisms, taking both proximal and distal factors into account, to work towards equity in health outcomes.

Professional who attended childbirth and breastfeeding in the first hour of life.

OBJECTIVES: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. METHODS: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. RESULTS: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. CONCLUSIONS: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.