Breastfeeding practices after a counselling intervention for factory workers in Bangladesh.

Breastfeeding may be particularly challenging for female factory workers who have long working hours and inadequate access to health information and care. In Chattogram, Bangladesh, a peer counselling intervention was undertaken to improve infant feeding practices of factory workers. Counselling started during pregnancy and continued until children were 18 months old. This article presents the results of a cross-sectional survey undertaken during 2 weeks in March-April 2017, after the project's conclusion. The aim was to compare breastfeeding practices, specifically early breastfeeding initiation and exclusive breastfeeding (EBF), among factory workers who had received peer counselling in the intervention areas (IA) with those of non-counselled factory workers in the nearby comparison areas (CA). Six female interviewers, trained over 3 days, conducted interviews at the workers' homes. Data were analysed to assess the association of peer counselling with infant feeding practices. Factory workers (N = 382) with infants between 0 and 18 months of age participated in the survey, in IA (n = 188) and in CA (n = 194). Although there were more health facility deliveries among the CA workers, only 43 (22%) of those workers had initiated breastfeeding within 1 h of birth versus 166 (88%) of the IA workers (p < .001). EBF prevalence on 24-h recall in infants aged 0-6 months was only 7/83 (8%) for the CA workers versus 73/75 (97%) for IA workers (p < .001). The survey showed that breastfeeding practices of factory workers in the IA after the intervention were significantly better than those of factory workers in the CA.

Selection criteria for wet-nurses: Ancient recommendations that survived across time.

This article will describe the content of the key criteria for the selection of wet nurses that persisted across time and the authors who transmitted this advice. Where relevant, it will include variations, such as additional recommendations or a different weighting being given to one or other criterion by a particular author. The focus is on the selection of a wet nurse for the employer's baby. The factors that led a woman to enter this employment and the consequences for her own baby will not be addressed here as they will be discussed elsewhere. The article is an historical one, drawing on primary sources, where possible, and important secondary sources. Guidelines for the selection of wet-nurses have existed from antiquity to the early 20th century. The key recommendations managed to survive across the centuries because they were considered useful by influential ancient and Early Modern and later authors who passed them on through copying and translations. It is tempting to assume that the prescriptive advice was followed by physicians and mothers. However, the discussion will raise doubts about whether the criteria were adhered to by physicians and parents, particularly when wet nurses were in scarce supply.

Assumptions and advice: mothers and Queensland well-baby clinics. A review.

In 20th century Australia, free well-baby clinics were run by maternal and child health nurses, although the funding and organisational structure varied from state to state. It was assumed that women who attended followed the advice assiduously; yet attendance did not necessarily equate to practice. In Queensland, the state government's free Maternal and Child Welfare Service (MCW) advised mothers on infant feeding and care through well-baby clinics throughout the state, a correspondence section for mothers in remote areas and a railcar clinic to some western towns, under the state government's policy of covering every mother and baby in Queensland. Women in Queensland, as in other states, were exposed to other influences on how to feed babies and often exercised agency in making their own decisions according to their circumstances and their own judgment. This review will place research from Queensland on women's reasons for attending the clinics and adherence to the advice provided, during the period 1920-1965, within a wider context. This includes research on barriers to following advice, counselling versus imparting information and the mother's self-efficacy. The message for today is that adherence to advice still cannot be assumed and mothers' own circumstances need to be factored in.

Human milk banking to 1985.

This paper provides a literature review of the use of donor human milk by hospitals in Australia and elsewhere from the postwar period through to the early 1980s, and establishes the context for a small study of practices which happened in that period. The latter study will be reported elsewhere. The purpose of this paper is to provide a resource for future comparison when the history of the new hospital milk banks of the 21st century is written. Relevant literature in English and two articles in French were accessed.

Human milk use in Australian hospitals, 1949-1985.

This paper will draw mainly on the experiences of fourteen women to explore the use of expressed human milk by hospitals in Australia from the postwar period through to 1985. The purpose is to provide a snapshot of common practices before the decline of human milk banking and other uses of expressed breastmilk in Australian hospitals, thus providing a source for future comparison against the more rigorous, uniform practices being instituted in the new milk banks of the early-21st century. The ten mothers included were a convenience sample drawn from the author's networks, with recruitment continuing till a range of hospital types and a majority of states were included. Three of the mothers also had experience as trainee midwives and midwives, and four midwives contributed their experiences as staff members, only. The hospitals ranged from large teaching hospitals to small private hospitals and were in metropolitan, regional and country locations. The practices included routine expression and expression for specific purposes, whether for the mother's own baby or to donate. Some hospitals pooled the donor milk for premature or sick babies.

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."

Supporting Exclusive Breastfeeding Among Factory Workers and Their Unemployed Neighbors: Peer Counseling in Bangladesh.

BACKGROUND: Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers. RESEARCH AIM: To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh. METHODS: A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors' influence on breastfeeding practices. RESULTS: Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed. CONCLUSIONS: Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

Mothers' experiences of sharig breastfeeding or breastmilk co-feeding in Australia 1978-2008.

While the concept of breastfeeding in contemporary Western culture is of a mother breastfeeding her own baby or babies, others have replaced the mother as provider of breastmilk, for a variety of reasons, through most periods of human existence. Existing policies for the sharing of this bodily fluid, milk, appear to have been written without the benefit of a detailed examination of the actual experiences of the mothers and babies involved. This study attempts to fill this information gap by investigating the sharing of breastfeeding or expressed breastmilk by Australian women in a recent thirty-year period, 1978-2008. The objective of this study was to explore the mothers' experiences of sharing breastfeeding or human milk including: the circumstances in which this bodily fluid was freely shared; what screening process, if any, was used before the milk of another mother was accepted; the mothers' feelings about the experience; the reported attitudes of others; and the children's behaviour when put to the breast of someone other than the mother. The underpinning reason for the sharing of breastfeeding or breastmilk was the desire of mothers to provide human milk to their babies, exclusively, including while they were absent or temporarily unable to breastfeed. Most mothers were selective about those with whom they would share breastfeeding or breastmilk.

Is breastfeeding 'normal'? Using the right language for breastfeeding.

BACKGROUND: Accurate terms aid clarity in thinking and prevent confusion. In the infant feeding field 'normal' can be ambiguous as biologically normal may not equate with culturally normal in a given time or place. Similarly, the use of the term 'intervention' is appropriate if a recommended practice is not perceived as 'normal' to that culture. OBJECTIVE: This article explores the meaning of 'normal' in the context of infant feeding, since mothers may not perceive breastfeeding as 'normal' when this differs from the experience in communities in which it is considered unusual. METHODS: Historical and recent sources were used to explore the effect of culture and established practice on perceptions of what is 'normal'. DISCUSSION: Iceland and several regions of Europe are used as examples of long-term abandonment of breastfeeding during the late Medieval and Early Modern periods and the 19th century. Ireland, the United Kingdom and the United States are discussed in relation to fluctuations and declines in breastfeeding prevalence in the 20th and 21st centuries. The rôle of science and the rise of mother-support groups for breastfeeding, interventions to promote breastfeeding, and the possibility of cultural change, are also discussed. IMPLICATIONS FOR PRACTICE: Culture influences the perception of what is 'normal' and where a culture has abandoned breastfeeding, or where it is in decline, women are unlikely to view it as the normal way to feed an infant. A more appropriate use of language is recommended, describing breastfeeding as 'biologically normal' or 'physiologically normal', as it is not always, and has not always been, culturally normal. In this context initiatives to improve breastfeeding rates can correctly be termed 'interventions'.

Sharing breastmilk: wet nursing, cross feeding, and milk donations.

Wet nursing and cross feeding both involve the breastfeeding of a child by someone other than the mother. Wet nursing involves a woman who is not the social equal of the employer, is never reciprocal, and is normally for payment. Cross feeding (also 'cross nursing') is the informal sharing of breastfeeding between equals, and is usually unpaid and may be reciprocal. Community attitudes in the late 20th and early 21st centuries are distrustful of this practice, though satisfaction is reported by the women involved in sharing breastfeeding. Community unease has included feelings of revulsion, rationalized by concern about the transmission of infections. Yet recently there have been sporadic feature articles in the print media reporting instances of, and opinions, on these practices. This review article explores the sharing of breastfeeding, principally in Australia, and provides an historical context for concerns about transmission of infection. These issues will also be discussed in relation to human milk banking.

Latch and the fear response: overcoming an obstacle to successful breastfeeding.

A cringe response, born of fear of anticipated nipple pain, creates behaviours that undermine comfortable latch of baby at breast, resulting in the pain th women feared. Fear is an important response in human survival but sometimes the behaviours resulting from the fear are inappropriate. This case study discusses the psychological processes and specific physical responses observed in a woman who is experiencing nipple pain during breastfeeding. It describes steps that can be taken to assist the mother in identifying what she is doing, educating her about the processes involved, and providing her with strategies to override the inappropriate response.

Breast hypoplasia and breastfeeding: a case history.

Hypoplasia, or glandular insufficiency, of the breasts is an infrequent cause of breastfeeding failure or infant failure to thrive. Early evaluation of the breasts of early identification of infant indicators can enable mothers to breastfeed while providing appropriate supplementation to facilitate satisfactory hydration and growth. A case report is presented of a highly motivated mother with minimal breast tissue who was able to soothe four of her infants at her breasts, supplying some breastmilk, while providing the bulk of their nutritional requirements by other means. At the time of writing she is tandem breastfeeding as well as providing artificial milk by bottle.

The Tenth Step of the BFHI: What midwives need to know about optimal support for mothers, post-discharge.

This commentary discusses the 10th Step of the Baby-Friendly Hospital Initiative (BFHI), the only step that goes beyond the hospital to provide for the mother to receive breast-feeding support after she returns to the community. The reasons why such support is needed, and how this support has been provided in different settings, will be discussed. Post-discharge support for breast-feeding mothers takes many forms and is optimised when mothers can access both professional and peer support. The mother-baby dyad is best served by the right advice from the right person at the right time. Midwives who assist the new mother with information about easily accessible support in the community enable the care she has received during her short hospital stay and during any midwifery home visiting to continue when she is in an environment that may not be supportive of breast feeding.

Printed advice on initiating and maintaining breastfeeding in mid-20th-century Queensland.

This article, which is part of a larger historical study of infant-feeding advice received by mothers in Queensland, Australia, identifies and examines print materials that were used by mothers, or that influenced other texts, during the postwar period from 1945 to 1965. The texts are described within the context of their environmental influences and the medical knowledge and research of the time to assess what effect, if any, these latter materials had on the established system of infant-feeding advice. Two innovations that were employed are the use of interviews to identify the most-used texts and the comparison of popular advice books with medical journal material.

Maternal dietary advice as an artifact of time and culture: post-World War II Queensland, Australia.

Dietary advice to breastfeeding mothers in post-World War II Queensland, 1945-1965, was not evidence-based, but based on cultural beliefs. Diet-based recommendations for boosting the breastmilk yield included increased intake of milk and protein foods, food supplements, especially chocolate-flavoured supplements, and tablets. Although community beliefs about foods to be avoided during lactation were reflected in informal advice, foods such as green leafy vegetables were specifically recommended by the print materials of the period as part of a healthy diet during breastfeeding.

Milk siblingship, religious and secular: History, applications, and implications for practice.

PROBLEM OR BACKGROUND: Milk kinship has religious and practical importance to Muslim families that is not well understood in Western cultures. The relationship occurs when an infant receives the milk of a woman other than the biological mother, creating familial relationships between the child and the woman whose milk is received. As milk siblings, her children and the recipient infant must never marry each other. Midwives in Western countries may encounter this in relation to human milk banking. AIM: This review provides a context for respectfully assisting families with their decision making when they are offered banked milk. METHODS: A database search was conducted and other publications were found manually. REVIEW/FINDINGS: Milk siblingship can be religious or secular. In Islam similar prohibitions on marriage exist to those for blood relations. The mothers therefore have to be known to each other to prevent an inappropriate marriage. This relationship has been a barrier to use of human milk banks by Muslim families as milk from several mothers is usually pooled. Nevertheless, donor milk has been used for premature neonates in two Islamic countries, applying the religious requirements. Recent interpretations by some Islamic scholars permitting milk banking may be acceptable to some families, but others will heed other rulings. CONCLUSION/IMPLICATIONS: NICU staff may encounter difficulties in providing banked human milk to infants from Muslim families. Different rulings exist and Muslim families in Western countries come from a variety of traditions. Sensitivity is required to explore these issues with families.

Human milk banking in the volunteer sector: policy development and actuality in 1970s Australia.

OBJECTIVE: to describe the development of rigorous milk banking policies in the voluntary sector in Australia, 1975-1979, by the non-government organisation, the Nursing Mothers' Association of Australia (now the Australian Breastfeeding Association), and the eventual abandonment of milk banking by the organisation. DESIGN: historical article. SETTING: Australia in the years 1975-1979. CONCLUSIONS: during the period in which the policy development described here took place, conducting a milk bank to the rigorous standards set by the organisation required too heavy an investment of hours by unpaid volunteer coordinators to be sustainable. IMPLICATIONS FOR PRACTICE: in establishing and continuing a successful milk bank, models which depend less on volunteer hours may be more sustainable.