[Promotion program for breast feeding in Poland. II. Analysis of the breast feeding situation in Poland]. / Program promocji karmienia piersia w Polsce. Czesc II. Analiza sytuacji karmienia piersia w Polsce.

Assessment of breast-feeding situation in Poland was based on three kinds of nation-wide surveys conducted in 1988: newborn feeding and breast feeding routines in maternity wards epidemiology of breast-feeding and other feeding methods in first six months of infant life KAP study among MCH professionals The major findings of the surveys were: conflicting with lactation maternity wards routines especially: very initiation of breast-feeding, administration of liquids and formulas, rigid feeding schedule, separation of newborns from the mothers too early supplantation of breast-feeding lack of current breast-feeding knowledge among MCH professionals.

PIP: An analysis of the methods of infant feeding as well as of some of the influencing factors was carried out in 1988. In an analysis of 9299 neonates in 402 wards, it was attempted to find out whether the existing methods of neonatal protection presented any barrier to women starting lactation. Early initiation of breast feeding, 2 hours after labor, was done in only 5.72% of wards. The rest began during a period of 4-12 hours after birth. After cesarean section breast feeding started the day after in 29.35% of wards, although in a few it started 2-6 hours postpartum. 71.25% of the wards were feeding the infants according to a schedule. 47.25% of wards fed the infants a mixture at night, and 37.5% weighed the infants before and after breast feeding. Premature infants were not breast fed: 50-100% were fed concentrated nourishment. 12.97% of neonates were given exclusively artificial formula vs. 52.49% of premature infants. 22.02% of neonates and 8.66% of preterms were also supplemented with a milk mixture. 52.95% of neonates and 58.86% of preterms were also regularly given fluids. Exclusive breast feeding was atypical in most wards: 84.03% of neonates and 16.54% of preterms were breast fed but also give supplements. The international organization ESPAGON, engaged in infant nutrition, studied a sample of 2246 Polish infants aged 7 months, 2027 of whom had breast fed for some time. At 4 months, 93.88% had received fluids, 86.46% mixtures, and 43.06% got vegetable--fruit juices with breast feeding. 78.71% of infants received vegetable soup at 4 months. After 6 months only 4.59% of breast-fed infants were not supplemented with fluids, 7.30% were supplemented with milk other than mother's milk, 5.48% did not get fluids, and 5.52% did not get vegetable soup. 908 health workers were studied regarding their knowledge of child nutrition. Although research findings recommend exclusive breast feeding, 94% of health workers recommended vegetable-fruit juice supplements and 65.9% vegetable soup for nursing infants before 4 months of age.

[Promotional program for breast feeding in Poland. III. Proposed organizational implementation]. / Program promocji karmienia piersia w Polsce. Czesc III. Proponowane rozwiazania organizacyjne.

On the basis of the experience and data gained during breast-feeding situation assessment process (see Part II) the major activities of the breast-feeding promotion programme were identified as follows: 1. Training of health workers which aims the revision and change of practices in health services responsible for mother and child care. 2. Education of population about advantages of breast milk and breast-feeding management. The detailed project of the implementation of the programme on the national scale was presented.

PIP: A number of priorities arise in promoting the breast feeding program in Poland. Education is one, as the lack of information is the main obstacle to promotion of breast feeding. It is of major importance to organize a central training program for health care workers and for society at large. The procedures in health institutions have to be altered. Counselors for women, for neonatal wards, and for child care have to prepare women for breast feeding. The district midwife, nurse, and counseling center workers have to collaborate in stabilizing breast feeding in the first 4-6 weeks to assure its continuation at least until 6 months of age. Auxiliary measures help protect lactating working women and control the artificial formula market in the face of burgeoning harmful free-market practices. The objectives of the program are to increase the percentage of infants breast fed after birth to 94% by 2000 and the percentage of those breast fed up to 6 months to 70% The goals are the establishment of the breast feeding program in all countries by the end of 1992; the training of maternal and child health care workers in the promotion of breast feeding by the end of 1993; and the expansion to 70% of wards where mothers and infants room in together. This system should cover 80% of infants nationally. 85% of neonates should be exclusively breast fed in wards by the end of 1995. 50% of infants should be exclusively breast fed up to 4 months by 1997. The program will be carried out at 3 levels; 1) central level (coordination and financing by the Ministry of Health); 2) county level (courses for a unit consisting of a pediatrician or neonatal doctor and supervising nurses); 3) basic health promotion level (counselors for women and neonatal wards to facilitate breast feeding).

[Program for promotion of breast feeding in Poland. I. Justification of the program with supporting information]. / Program promocji karmienia piersia w Polsce. Czesc I. Uzasadnienie programu i informacje wprowadzajace.

A breast-feeding promotion programme for Poland was developed as a part of governmental programme to protect and improve health of the mother, child and family for the years 1986-2000 carried out by Institute of Mother and Child. It was presented as a document consisting of three major components which will go to press successively. Part I covers justification of the proposed programme activities and thirty five consistent paragraphs summarizing principal information on breast-feeding and its promotion.

[Breast feeding of twins with regard to pre-term infants]. / Karmienie piersia blizniat z uwzglednieniem urodzonych przedwczesnie.

The benefits of breast-feeding for health and development pre-term and full-term infants changed the attitude towards nutrition of twins and higher-order multiples. Mothers of twins are often at risk of unsuccessful initiation of lactation while in hospital. The possibilities to provide appropriate intervention and support when a mother breastfeeds twins are presented.

[Breast feeding as a component of reproductive health]. / Karmienie piersia jako element cyklu rozrodczego kobiety.

Extensive research, especially in the recent years documents the divers advantages of breastfeeding not only for infants but also for breastfeeding women and their reproductive health. The paper presents the results of epidemiological studies concerning protective effects of breastfeeding against large number of acute and chronic diseases of childhood and possible health benefits for mothers like fertility regulation, stimulation of parenting abilities and protection against breast and ovarian cancer, bone loss, nutritional depletion. The recommendations of hospital postpartum care supportive to physiological initiation of breastfeeding, based on the experience of Baby Friendly Hospital Initiative implementation in Poland is also presented.

[Determination of newborn feeding in maternity hospital care. Part I: Factors associated with breast feeding initiation]. / Uwarunkowania zywienia noworodków w szpitalnej opiece poporodowej. Czesc I: Czynniki wplywajace na rozpoczecie karmienia piersia.

The data on 11,750 newborns collected in 427 hospitals during the survey of maternity words practices in 1995 were used to analyse the factors related to breastfeeding initiation while in hospital. The statistical analyses were done using percentage of newborn breastfed as well as odds ratio (OR) and population attributable risk in percent (PAR%) of artificial feeding. The identified factors of artificial feeding were: newborn birth weight < 2500 g (OR = 28.2; PAR = 52%), complications in neonatal period (OR = 10.3; PAR = 64%), caesarean section (OR = 4.3; PAR = 32.2%), mother and newborn separation longer than 1h/24h (OR = 13%; PAR = 87.2%), lack of skin-to-skin contact after birth (OR = 8.5; PAR = 60.9%).

[Determinants of newborn feeding in maternity hospital care. Part II: factors associated with exclusive breast feeding]. / Uwarunkowania zywienia noworodków w szpitalnej opiece poporodowej Czesc II: czynniki warunkujace wylaczne karmienie piersia.

OBJECTIVES: To study the effects of newborn status and hospital practices on exclusive breast-feeding in a maternity ward. DESIGN: National survey conducted in January 1995 in 427 hospitals. MATERIALS AND METHODS: Data on 11,422 newborns obtained from hospital staff. Statistical analysis was performed using odds ratios (OR), population attributable risks (PAR%) and logistic regression method. RESULTS: The most important factors for supplementation were: caesarean section (OR = 5.3; PAR = 19.0%), first breastfeeding later than 2 h after birth (OR = 5.2; PAR = 41.3%), mother and newborn separation longer than 1 h/24 h (OR = 3.4; PAR = 44.9%). Logistic regression analysis showed that first feeding in 2 hours is the main prognostic factor for exclusive breastfeeding in a maternity ward. CONCLUSIONS: Changes in hospital practices increase the proportion of exclusively breastfeeding infants during stay in the maternity ward.

[Analysis of newborn nutrition in obstetric-neonatal hospital departments]. / Analiza sposobu zywienia noworodków na oddzialach polozniczo-noworodkowych.

The procedures used in obstetric-neonatal wards may stimulate or disturb lactation. Changes of hospital routine are an important element of the more widespread use of breast feeding. In the paper procedures applied in the observed wards are presented showing that the organization of neonatal care in most wards was insufficient form normal beginning and maintenance of lactation. Suggestions are outlined of organizational changes in the wards and the possibilities of their monitoring are indicated.

[Preparation of health personnel for the promotion of breast feeding--a pilot study. (Part I--the level of knowledge)]. / Przygotowanie personelu sluzby zdrowia do upowszechniania karmienia piersia--badanie pilotazowe (Czesc I--Wiedza).

The study is a part of a preliminary analysis of the situation before introducing the promotion program of breast-feeding. It concerns the assessment of the knowledge of lactation physiology and properties of human milk among health service workers employed in mother and child health care. Significant deficiencies of knowledge on this subject were found. The obtained information was used for outling the directions of indispensable training.

[Education of health personnel for promotion of breast feeding--pilot studies. II--Attitudes]. / Przygotowanie personelu sluzby zdrowia do upowszechniania karmienia piersia--badania pilotazowe. Czesc II--Postawy.

The study was carried out for investigating the attitudes towards breast-feeding among doctors, nurses, and midwives working in primary health service units providing care for mother and child in certain areas. Generally the attitudes were found to be positive. However, a great part of the studied personnel did not identify themselves with the possibility of actual activity for breast-feeding in their professional role. The necessity was stressed of a more precise outlining of the duties of various groups of health service workers and incorporation of activating mechanisms into it.

[Preparation of health service personnel for widespread use of breast feeding--a pilot study. Part III--Practice and declared contraindications to breast feeding]. / Przygotowanie personelu sluzby zdrowia do upowszechniania karmienia piersia--badanie pilotazowe. Czesc III--Praktyki i deklarowane przeciwwskazania do karmienia piersia.

The purpose of the study was a trial to find out in what degree the activities and suggestions of health service personnel with respect to pregnant women and lactating mothers might be an obstacle in beginning and maintaining of lactation. A high percent of studied personnel declared activities incompatible with a successful course of lactation and excessive extension of indications to artificial feeding of infants. A general direction was established for intervention within the framework of the programme of activities for breast-feeding.

[Barriers in breast feeding: marketing of breast feeding substitutes]. / Bariery w karmieniu piersia: marketing produktów zastepujacych karmienie.

The most important techniques and strategies of marketing breast-feeding substitutes with special consideration of Polish market are discussed. WHO/UNICEF Code recommendations are presented.

[Barriers in breast feeding: contraindications]. / Bariery w karmieniu piersia: przeciwwskazania.

Breast-feeding is the important factor for mother and child health. Many reasons for stopping breast-feeding are not the real contraindications. The most frequent maternal and child contraindications are discussed.

[Barriers in breast feeding: artificial nipples and nipple shields]. / Bariery w karmieniu piersia: smoczki i kapturki.

Early use of artificial nipples and nipple shields results in nipple confusion. This was identified as one of the most important barriers in successful breast-feeding. Alternative method of feeding can prevent breastfeeding problems.

[III. Barriers in breastfeeding: hyperbilirubinemia]. / III. Bariery w karmieniu piersia: hiperbilirubinemia.

Hyperbilirubinemia is a very frequent reason for interrupting breastfeeding in Poland. The pathogenesis of the early and late jaundice related to breastfeeding is discussed. The lack of contraindication to breastfeeding is stressed.

[Barriers in breast feeding: cesarean section]. / V. Bariery w karmieniu piersia: cesarskie ciecie.

The rate of cesarean sections in Poland is about 15%. The post partum practice conductive to breast-feeding are less frequently introduced in after caesarean delivery even after adjustment for newborn birth weight. Measures to foster and facilitate successful breast-feeding after caesarean delivery are recommended.