Maternal Reasons for Early Termination of Exclusive Breastfeeding in Premature Infants: A Prospective Study.

PURPOSE: Maternal concerns for health and growth in prematurely born infants affect the breastfeeding duration. METHOD: This prospective observational study evaluated whether maternal concerns regarding insufficient milk supply were supported by inadequate nutrients in human milk or low infant growth. The study followed mothers of 211 premature born infants for 6 months after delivery. RESULTS: Of the 211 infants, 156 were not exclusively breastfed for the recommended 6 months after delivery. For 79 of these 156 infants, termination was due to maternal concerns regarding insufficient milk supply. There was no difference in human milk nutrients or infant growth when comparing infants who were exclusively breastfed with those who were not. CONCLUSION: Maternal concern regarding insufficient milk supply was the primary explanation for termination of exclusive breastfeeding after premature delivery. Concerns regarding insufficient milk supply were not found associated with inadequate nutrients in the human milk, nor with low infant growth. IMPLICATIONS: Breastfeeding support should remain in focus in this population.

Breastfeeding Self-Efficacy, a Predictor of Early Cessation of Exclusive Breastfeeding Among Mothers Giving Birth Preterm.

The aim was to describe the prevalence of exclusive breastfeeding among mothers of premature infants and investigate the extent to which breastfeeding self-efficacy is associated with early cessation of exclusive breastfeeding. The study population consisted of 136 mother-infant dyads with information on the outcome of exclusive breastfeeding and exposure of self-efficacy, recruited between September 2016 and February 2018. Data were collected via questionnaires with follow-up at 6 months. The statistical analysis included descriptive analysis with survival curves and logistic regression analysis. At 2 months, 101 (74%) premature infants were exclusively breastfed; at 4 and 6 months, 82 (60%) and 41 (30%), respectively. Higher levels of self-efficacy were significantly associated with breastfeeding exclusively for 2 months (P = .03). In multivariate analysis, mothers who had a low level of early self-efficacy toward breastfeeding had 2½ times higher odds of breastfeeding cessation before 2 months (odds ratio = 2.63, 95% confidence interval: 1.16-5.96). The risk did not change when adjusted for potential confounders. Breastfeeding self-efficacy is an early predictor of exclusive breastfeeding for 2 months of the premature infant. Health professionals should use self-efficacy as a prognostic factor to identify mothers at risk of early cessation of breastfeeding and support those with low self-efficacy to increase duration of exclusive breastfeeding.

Knowledge of mothers and fathers' experiences of the early in-home care of premature infants supported by video consultations with a neonatal nurse.

AIM: To gain in-depth knowledge of mothers' and fathers' experiences of the whole trajectory of an early in-home care programme supported by video consultations with a neonatal nurse. DESIGN: A qualitative interview study. METHODS: Data were collected through dyadic semi-structured interviews with mothers and fathers participating in virtual early in-home care programmes and were subjected to inductive content analysis. FINDINGS: The mothers and fathers were anxious about mastering the care of their premature infants at the start of the early in-home care phase but gradually developed confidence by the completion of the early in-home care programme. Being at home during the early in-home care programme gave the mothers and fathers an opportunity to test their decision making concerning the care of the infant while having the ability to obtain support from nurses when needed. CONCLUSION: Our findings indicate that the trajectory of early in-home care programmes combined with video consultations contributes to parents' increased confidence as mothers and fathers. TRIAL REGISTRATION: Clinical trial registration: REG-113-2014 and SJ-431 .

Randomised oral stimulation and exclusive breastfeeding duration in healthy premature infants.

AIM: Although exclusive breastfeeding is recommended for all newborn in the first 6 months of life, only 13% of Danish premature infants complies with this. This trial aimed to examine whether oral stimulation prolonged exclusive breastfeeding in premature infants. METHOD: A randomised controlled trial was conducted at the Neonatal Intensive Care Unit, Hvidovre Hospital, Denmark between 2016 and 2018. Systematic oral stimulation was performed by the parents after training by occupational therapists. Primary outcome was exclusive breastfeeding duration with 6 months' follow-up, analysed by intention-to-treat. RESULTS: Included were 211 infants (53% boys) with a mean gestational age of 231 days, allocated in ratio 1:1 to oral stimulation or standard care. There was no difference in exclusive breastfeeding duration between infants orally stimulated and control infants. Thus, for orally stimulated infants, median duration was 122 days (interquartile range 40-183) in contrast to 154 days (interquartile range 61-183) for the controls, P value .16. At 6 months of age, 27% of orally stimulated infants were exclusively breastfed compared with 25% of controls. CONCLUSION: In healthy premature infants, oral stimulation performed by parents has no long-lasting effect on breastfeeding duration. Attention should be directed to parental education and involvement.

No long-term effect of oral stimulation on the intra-oral vacuum in healthy premature infants.

AIM: Exclusive breastfeeding is recommended for the first 6 months of life, but the breastfeeding rate in premature infants is low. We examined the effect of oral stimulation on infant's strength of suction and the relation between this intra-oral vacuum and breastfeeding duration. METHOD: Between 2016 and 2018, 211 infants in a Danish neonatal unit were randomised 1:1 and of these 108 to oral stimulation intervention and 103 to control. Suction was measured as peak vacuum at enrolment and a corrected age of 6 weeks. Breastfeeding duration was registered. RESULTS: Vacuum increased from enrolment to a corrected age of 6 weeks in all infants, and no effect of oral stimulation intervention was demonstrated P = .08. Infants born ≤32 gestational weeks had lower vacuum compared with infants born after, 350 vs 398 mbar P < .001. For infants born after 32 gestational weeks, the odds ratio for exclusive breastfeeding at 6 months was 1.99 per 100 mbar increase in vacuum P = .01. CONCLUSION: In our study, infant's intra-oral vacuum increased with age and was not affected by the oral stimulation intervention. For infants born after 32 gestational weeks, the exclusive breastfeeding rate was positively associated with a strong vacuum.

The significance of early breastfeeding experiences on breastfeeding self-efficacy one week postpartum.

Many new mothers do not reach their breastfeeding goals. Breastfeeding self-efficacy is a modifiable determinant influenced by prior and new breastfeeding experiences. More knowledge about factors associated with early breastfeeding experiences and breastfeeding self-efficacy would allow us to qualify breastfeeding counselling and increase breastfeeding duration. This study aimed to identify prevalence and factors associated with early negative breastfeeding experience, low breastfeeding self-efficacy in the first week postpartum, and drop in self-efficacy from late pregnancy to early postpartum period. A prospective longitudinal study was performed in Denmark from 2013 to 2014, including 2, 804 mothers. Results showed that 1 week postpartum almost 10% of mothers had negative breastfeeding experiences, 36% had low breastfeeding self-efficacy, and 26% drop in self-efficacy from pregnancy. Negative breastfeeding experiences were significantly associated with epidural analgesia, interrupted skin-to-skin contact immediately postpartum, short previous breastfeeding duration, and lacking social support. Low breastfeeding self-efficacy was associated with low breastfeeding intention, short previous breastfeeding duration, and negative breastfeeding experiences in the first week postpartum. Finally, significant associations of drop in breastfeeding self-efficacy from late pregnancy were no or short education, early negative breastfeeding experiences, prior short breastfeeding duration, and low general breastfeeding self-efficacy in pregnancy. Negative breastfeeding experiences in the first week postpartum is crucial for maternal breastfeeding self-efficacy 1 week following birth. It is important to identify and support mothers at risk of negative breastfeeding experiences in the first week following birth and address factors that might increase the probability of early successful breastfeeding experiences.

Health visitors' competences before and after implementing the newborn behavioral observations (NBO) system in a community setting: A cluster randomised study.

OBJECTIVE: To explore differences between health visitors' competences before and after implementing the newborn behavioral observations (NBO) system in four Danish municipalities. DESIGN AND SAMPLE: In a cluster randomized design, 56 and 55 health visitors were enrolled in the intervention and comparison districts. Only health visitors from the intervention district received the NBO education programme. MEASUREMENTS: Data from self-administered questionnaires on heath visitors' intention, self-efficacy, knowledge, and observation skills were collected before and after NBO training. Data were analysed using descriptive and multivariable analyses. RESULTS: Health visitors reported high levels of intention, self-efficacy, and knowledge working with early parent-infant relationships in both groups at baseline. After implementing NBO, the intervention health visitors reported a significantly higher level of knowledge of infant self-regulation than the comparison group. No significant differences were found in health visitors' level of intention and self-efficacy working with early parent-infant relationships, or in health visitors' observation skills assessing the quality of early relationship. CONCLUSIONS: Health visitors attending the NBO education and working with NBO in clinical practise had a significantly higher level of knowledge of infant self-regulation. A new discussion of how to educate health visitors' competencies working with early relationship in clinical practise is needed.

The role of intention and self-efficacy on the association between breastfeeding of first and second child, a Danish cohort study.

BACKGROUND: The impact of parity on breastfeeding duration may be explained by physiological as well as psychosocial factors. The aim in the present study was to investigate the mediating influence of intention and self-efficacy on the association between the breastfeeding duration of the first and the following child. METHODS: A 5-year Danish cohort study with data from online questionnaires was used. Data came from 1162 women, who participated in the "Ready for child" trial in 2006-7 and gave birth to their second child within 5 years in 2011-3. Analysis included multiple regression models with exclusive/any breastfeeding duration of first child as the exposure variables, intention and self-efficacy measured as mediators, and exclusive/any breastfeeding duration of the second child as the outcome variables. RESULTS: Duration of exclusive breastfeeding of the first child was significantly associated with exclusive breastfeeding duration of the second child (p <  0.001) and with the self-reported intention and self-efficacy in the ability to breastfeed the second child (p <  0.001). The exclusive breastfeeding period was slightly longer for the second child. Self-efficacy and intention mediated the association between breastfeeding duration in the first and second child. Together the two factors explained 48% of the association in exclusive breastfeeding and 27% of the association in any breastfeeding between the first and second child. CONCLUSION: Due to a reinforcing effect of intention and self-efficacy, breastfeeding support should focus on helping the first time mothers to succeed as well as to identify the second time mother with low self-efficacy and additional need for support.

What are the effects of supporting early parenting by enhancing parents' understanding of the infant? Study protocol for a cluster-randomized community-based trial of the Newborn Behavioral Observation (NBO) method.

BACKGROUND: Support to strengthen the early parent-infant relationship is recommended to ensure the infant's future health and development. Little is known about the universal approaches taken by health visitor to support this early relationship. The aim of this study is to investigate the effects of health visitors' use of the Newborn Behavioral Observation (NBO) method among new parents. METHODS: This is a cluster-randomised community-based study implemented in four Danish municipalities. Health visitors will conduct the trial, and the geographical districts they work in will constitute the clusters as units of randomisation. The participants will be approximately 2800 new families, randomised into an intervention or a comparison group according to their health visitor. The families are recruited at the first postpartum home visit. Parents in both groups receive care as usual: parents in the intervention group also receive the standardised NBO method in home visits performed from 3 weeks to 3 months postpartum. Data consist of self-reported parent questionnaires and video recordings of a selected group of vulnerable first-time mothers recorded 4 months postpartum. The self-reported data are obtained: at baseline 1 week postpartum and then at follow-up 3, 9 and 18 months postpartum. Data will be analysed using the intention-to-treat method and the analyses will include comparison of change in the primary variables across time supplemented by multiple regression analysis. The primary study outcomes are measured by the following factors: parental confidence, infants' socio-emotional development and mother-infant relationship. Other measures include parental mood and stress, breastfeeding duration and utility of the health visitor services. Data collection among the health visitors in both groups will serve to monitor any change in practice regarding the work with early parent-infant interactions. DISCUSSION: This protocol describes an evaluation of the NBO method used universally in health visiting practice. The intervention seeks to support early parenting by increasing parents' understanding of their infants' cues. The NBO is currently implemented in Denmark even though an evaluation of the NBO has yet to be made in a community setting in Denmark and internationally. The study may contribute to building an increasingly evidence-based practice for health visitors. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03070652 . Registered February 22, 2017.

Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study.

BACKGROUND: Supporting early mother-infant relationships to ensure infants' future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities. METHODS: This quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis. RESULTS: The levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93-10.09) compared with 7.62 (95%CI;7.03-8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96-10.14) compared with 7.83 (95%CI;7.19-8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88-9.99) in the intervention group compared with 7.73 (95%CI;7.13-8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13-33.94) compared with 35.29 (95%CI;34.07-36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22-41.98) compared with 40.10 (95%CI;39.65-40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE. CONCLUSION: The findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method. TRIAL REGISTRATION: This study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447 .

ARE HEALTH VISITORS' OBSERVATIONS OF EARLY PARENT-INFANT INTERACTIONS RELIABLE? A CROSS-SECTIONAL DESIGN.

Health visitors need competences to promote healthy early parent-infant relationships. The aims of this study were to explore whether there are differences between groups of health visitors with and without additional parenting program education in terms of their knowledge of infant-parent interaction and their observation and assessment skills of such interactions. The cross-sectional study included 36 health visitors' certified Marte Meo therapists and 85 health visitors without additional parenting program education. Health visitors' observation skills were measured assessing five video-recorded mother-infant interactions. A questionnaire was used to measure their intention, self-efficacy, and knowledge. More certified Marte Meo therapists than health visitors without additional parenting program education reported a significantly higher mean level of knowledge of the early relationship, 6.42 (95% CI; 6.18-6.66) versus 5.05 (95% CI; 4.86-6.10), p = .04; and more certified Marte Meo therapists than health visitors without additional parenting program education reported a higher mean level of knowledge of infant self-regulation, 2.44 (95% CI; 2.18-2.71) versus 1.83 (95% CI; 1.62-2.03), p < .001. In the latter group, 54% (95% CI; 0.43-0.64) reported a significantly higher need for further education versus 22% (95% CI; 0.11-0.39), p = .001. Compared to health visitors without any parenting program education, health visitors certified as Marte Meo therapists reported a significantly higher frequency of correct assessment of mothers' sensitivity in two of five video-recordings, with 77.78% (95% CI; 0.61-0.87) compared to 45.88% (95% CI; 0.35-0.57) in Video 3, p = .001, and 69.44% (95% CI; 0.52-0.82) compared to 49.41% (95% CI; 0.39-0.60) in Video 4, p = .04, respectively. The results of the present study support the use of video-based education of health visitors to increase their knowledge of and skills in assessing parent-infant interactions. Randomized controlled trials are needed to determine whether the improved level of health visitors' knowledge and observation skills may be assigned to participation in the Marte Meo education program.

Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding?

The present study addressed the contentious discussions about the benefits and risks of nipple shield use. The objective was to explore self-reported reasons for using a nipple shield and examine associations pertaining to the mother, the infant and duration of breastfeeding. Data were collected from 4815 Danish mothers (68%) who filled out a self-administered questionnaire with open and closed question. Data were analyzed by content and statistical descriptive and multivariable analysis. Results showed that 22% of the mothers used nipple shields in the beginning and 7% used it the entire breastfeeding period. Primiparae used nipple shields more often than multiparae, and early breastfeeding problems as well as background factors like lower age, education and higher body mass index were associated with a higher likelihood of using nipple shields. Characteristics of infants associated with introducing nipple shields were lower- gestational age and birthweight. The use of nipple shields was furthermore found to be associated with a threefold increased risk of earlier cessation of exclusive breastfeeding: among primiparae odds ratio = 3.80 (confidence interval 2.61-5.53); among multiparae odds ratio = 3.33 (confidence interval 1.88-5.93). Mothers' own descriptions underlined how various early breastfeeding problems led to the use of nipple shields. Some mothers were helped through a difficult period; others described the use creating a kind of dependence. The results highlight how nipple shields may help breastfeeding mothers in the early period but is not necessarily a supportive solution to the inexperienced mother who needs extra support in the early process of learning to breastfeed.

Focused breastfeeding counselling improves short- and long-term success in an early-discharge setting: A cluster-randomized study.

Length of postnatal hospitalization has decreased and has been shown to be associated with infant nutritional problems and increase in readmissions. We aimed to evaluate if guidelines for breastfeeding counselling in an early discharge hospital setting had an effect on maternal breastfeeding self-efficacy, infant readmission and breastfeeding duration. A cluster randomized trial was conducted and assigned nine maternity settings in Denmark to intervention or usual care. Women were eligible if they expected a single infant, intended to breastfeed, were able to read Danish, and expected to be discharged within 50 hr postnatally. Between April 2013 and August 2014, 2,065 mothers were recruited at intervention and 1,476 at reference settings. Results show that the intervention did not affect maternal breastfeeding self-efficacy (primary outcome). However, less infants were readmitted 1 week postnatally in the intervention compared to the reference group (adjusted OR 0.55, 95% CI 0.37, -0.81), and 6 months following birth, more infants were exclusively breastfed in the intervention group (adjusted OR 1.36, 95% CI 1.02, -1.81). Moreover, mothers in the intervention compared to the reference group were breastfeeding more frequently (p < .001), and spend more hours skin to skin with their infants (p < .001). The infants were less often treated for jaundice (p = 0.003) and there was more paternal involvement (p = .037). In an early discharge hospital setting, a focused breastfeeding programme concentrating on increased skin to skin contact, frequent breastfeeding, good positioning of the mother infant dyad, and enhanced involvement of the father improved short-term and long-term breastfeeding success.

Breastfeeding and introduction of complementary food in Danish infants.

AIM: The purpose of the present study was to describe early feeding patterns in Danish infants. METHODS: A self-administered questionnaire was sent to 7113 mothers of newborns in the western part of Denmark approximately 6 months postpartum. A total of 5127 mothers (72%) returned the questionnaire and 4526 (88%) of the responding mothers provided valid answers to questions on infant nutrition. RESULTS: Breastfeeding was initiated after birth by 97%. At the ages of 2, 4 and 6 months, 68%, 55% and 7% of the infants, respectively, were fully breastfed, i.e. they received mother's milk only. Full breastfeeding at 4 months was for infants significantly associated with higher birth weight, longer gestational age and singleton birth; for mothers it was associated with older ages, higher educational level, lower BMI and multiparity. During the first weeks, 14% of the infants were introduced to formula and this proportion increased to 32%, 43% and 74% at 2, 4 and 6 months, respectively. Only 20% of the infants never received formula during the first 6 months of life. Time for introduction of solid food was associated with breastfeeding status. At 4 months, 3% of the previously fully breastfed infants were introduced to solid food, 12% of the partially breastfed and 17% of the non-breastfed. At 6 months, 87% of the infants had been introduced to solid food. CONCLUSIONS: The majority of Danish mothers introduced infants to solid food between 4 and six months, and did not exclusively breastfeed until 6 months, as recommended by WHO.

Predictors for early introduction of solid food among Danish mothers and infants: an observational study.

BACKGROUND: Early introduction of complementary feeding may interfere with breastfeeding and the infant's self-controlled appetite resulting in increased growth. The aim of the present study was to investigate predictors for early introduction of solid food. METHODS: In an observational study Danish mothers filled in a self-administered questionnaire approximately six months after birth. The questionnaire included questions about factors related to the infant, the mother, attachment and feeding known to influence time for introduction of solid food. The study population consisted of 4503 infants. Data were analysed using ordered logistic regression models. Outcome variable was time for introduction to solid food. RESULTS: Almost all of the included infants 4386 (97%) initiated breastfeeding. At weeks 16, 17-25, 25+, 330 infants (7%); 2923 (65%); and 1250 (28%), respectively had been introduced to solid food. Full breastfeeding at five weeks was the most influential predictor for later introduction of solid food (OR = 2.52 CI: 1.93-3.28). Among infant factors male gender, increased gestational age at birth, and higher birth weight were found to be statistically significant predictors. Among maternal factors, lower maternal age, higher BMI, and being primipara were significant predictors, and among attachment factors mother's reported perception of the infant as being temperamental, and not recognising early infant cues of hunger were significant predictors for earlier introduction of solid food. Supplementary analyses of interactions between the predictors showed that the association of maternal perceived infant temperament on early introduction was restricted to primiparae, that the mother's pre-pregnancy BMI had no impact if the infant was fully breastfed at week five, and that birth weight was only associated if the mother had reported early uncertainty in recognising infant's cues of hunger. CONCLUSIONS: Breastfeeding was the single most powerful indicator for preventing early introduction to solid food. Modifiable predictors pointed to the importance of supporting breastfeeding and educating primipara and mothers with low birth weight infants to be able to read and respond to their infants' cues to prevent early introduction to solid food.

Obesity and early cessation of breastfeeding in Denmark.

BACKGROUND: Obesity is associated with early cessation of breastfeeding. Breastfeeding is multi-factorial, and several factors contribute to this association. Our aim was to investigate to what extent socio-demographic and psychosocial characteristics, parity and prenatal conditions could explain the association between high BMI and early cessation of breastfeeding. METHODS: We used data from a randomized trial of 1597 Danish mothers of singleton infants. Self-reported maternal postnatal weight and height were available from 1375 (86%). High BMI was defined as body mass index ≥ 32 kg/m(2) at ~17 days after delivery. Outcome was cessation of exclusive breastfeeding by 17 weeks post-partum used in proportional hazards regression models. RESULTS: In the unadjusted analysis, mothers with high post-partum BMI compared with other mothers had a significantly higher rate of cessation of exclusive breastfeeding, and were more frequently characterized by socio-demographic, psychosocial, perinatal and behavioural factors known to increase the risk of early breastfeeding cessation. In the adjusted analyses (n = 1226), the association between BMI and duration of exclusive breastfeeding depended on parity (P = 0.03). Among primiparae, high BMI was associated with nearly double the risk of early cessation of exclusive breastfeeding (HR = 1.74, 95% CI 1.21-2.50). Among multiparae, the association disappeared when adjusted for socio-demographic factors and previous breastfeeding experience (HR = 0.89, 95% CI 0.62-1.28). CONCLUSION: Parity and previous breastfeeding experience are important factors to include when studying the association between BMI and breastfeeding duration. Intervention to extend the duration of lactation among obese mothers should focus on those with no or little previous breastfeeding experience.

When breastfeeding is unsuccessful--mothers' experiences after giving up breastfeeding.

Some mothers have to give up breastfeeding even though they want to breastfeed. To give up breastfeeding can be a sensitive issue in a time when breastfeeding is promoted as the healthiest for mother and child. The aim of this study was to describe mothers' experiences after they gave up breastfeeding even though they intended to breastfeed. A qualitative social constructive approach was used to describe mothers' experiences after giving up breastfeeding. Danish first-time mothers who had expected and wanted to breastfeed were interviewed 4 months after birth. The interviews were analysed by meaning condensation. The mothers experienced that giving up breastfeeding was a crucial but necessary decision for the child's health and well-being. They tried to 'be on the side of the angels' by caring for and bonding with the child. The mothers were divided between expressing milk or formula feeding and initially felt especially insecure about which method to choose when not breastfeeding. It was difficult for them to face the world with a bottle, but they did not ask for help. The mothers found it hard to explain the difficulty they had experienced breastfeeding and they were concerned about what to do the next time around. The mothers always tried to do what they perceived was best for their child, but they were in a vulnerable position and not always supported and understood by the surroundings. Therefore, health professionals who focus on making new mothers feel successful need to be aware that mothers who have to give up breastfeeding need special attention and support.

The effect of early postpartum home visits by health visitors: a natural experiment.

OBJECTIVE: The purpose of this study was to assess if the absence of early home visits influenced the mothers' breastfeeding duration and use of medical services. DESIGN: Data from mothers who had given birth during a strike period were compared with data from a reference period with usual work practice. SAMPLE: The study included 3,834 newborn and 375 health visitors, 75 of whom worked during the strike period. INTERVENTION: All families were offered nonstandardized home visits after discharge in the reference period. During the strike, the service was based on individual risk assessment. RESULTS: Overall, no difference in breastfeeding duration between the two periods was seen, but unvisited mothers in the strike period had shorter durations of full breastfeeding than a comparable group of mothers in the reference period (p < .005). Moreover, mothers in the strike period reported a significantly higher use of medical services. The mothers' needs for postnatal visits differed depending on parity: primiparae underlined uncertainty, multiparae underlined previous breastfeeding experience. Mothers had missed out on guidance on all areas of the health visitors' service. CONCLUSION: Nonstandardized home visits by health visitors were associated with a longer breastfeeding duration. The postnatal visits depended on parity and unmet needs increased the use of medical services.

Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial.

INTRODUCTION: Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother-infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations. METHODS: This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations. RESULTS: The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants' requirement for medical services. No significant differences in secondary outcomes were observed. DISCUSSION: The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02581800.

Video consultation as nursing practice during early in-home care for premature infants and families viewed from the families' homes'.

AIM: This study examined how communication between nurses and families in video consultations in a neonatal early in-home care program unfolded in the context of parents' homes. DESIGN: A qualitative study based on focused observations supported by audio-recorded video consultations. METHODS: The data were collected through nine video consultations between nurses and families in an early in-home care program. The transcribed material was examined using inductive content analysis. FINDINGS: The analyses revealed the following themes: "Setting the scene," "Weight as a point of reference" and "The pros and cons of technology." The video consultations unfolded in a relaxed atmosphere, but also as one-way communication dominated by nurses, with the infant's weight as the focus. The study finds that a focus on training in video communication is needed to take full advantage of video consultations' potential.