[Hospital practices and breastfeeding cessation risk within 6 months of delivery]. / Observance des pratiques professionnelles recommandées en maternité et réduction du risque de sevrage de l'allaitement maternel dans les six premiers mois de vie.

BACKGROUND: The impact of maternity ward practices on breastfeeding duration remains uncertain in France. OBJECTIVE: This study aimed to determine whether compliance with an increasing number of Baby-Friendly Hospital Initiative recommended practices was associated with a decreasing risk for breastfeeding cessation within 6 months of delivery. METHODS: We analyzed the original data from a prospective cohort study carried out in eight maternity centers in France in 2005-2006. A pediatrician or a midwife prospectively collected data on breastfeeding initiation within 1h of birth, rooming-in 24h a day, pacifier non-use, and giving breast milk only for 908 mothers who were breastfeeding at discharge. RESULTS: Overall, 315 (34.7%), 309 (34.0%), 186 (20.5%), and 98 (10.8%) mothers experienced 4, 3, 2, or 0-1 maternity ward practices. The median breastfeeding duration was 18 weeks (25th-75th percentiles, 9 to >26), with 87.6% and 31.5% of mothers who were still breastfeeding by 4 and 26 weeks after delivery, respectively. After adjusting for study center and baseline characteristics, the hazard ratios of breastfeeding cessation associated with 3, 2, and 0-1 practices were 1.32 (95% confidence interval [CI], 1.06-1.64), 1.54 (95% CI, 1.20-1.98), and 1.59 (95% CI, 1.13-2.25) as compared with compliance with four practices (p for trend <0.001). CONCLUSION: Although the causal interpretation for this relationship remains speculative, these findings support interventions aimed to implement or reinforce Baby-Friendly Hospital Initiative recommended practices in order to establish prolonged breastfeeding and decrease the risk for early cessation after discharge to home.

[Performance of the Breastfeeding Assessment Score for the prediction of early weaning in France]. / Intérêt du Breastfeeding Assessment Score pour la prédiction du sevrage précoce de l'allaitement maternel en France.

BACKGROUND: The Breastfeeding Assessment Score (BAS) was derived to help identify mothers at increased risk of early weaning in United States. Data are currently lacking on the accuracy of the BAS for French mother-infant pairs. OBJECTIVE: To assess the accuracy of the BAS in a French validation cohort. METHODS: We used the original data from a prospective cohort study of 488 mothers who were breastfeeding at discharge in 9 maternity wards in 2005. The outcome measures were assessed using structured follow-up telephone interviews at 4 and 26 weeks. RESULTS: The weaning rate was 3% at 14 days of infant age. The corresponding area under ROC curve was 0.73 [0.60-0.85] and was comparable to that observed in the derivation cohort (0.75). For a cut point of 8 recommended by the authors of the BAS, 43% of mother-infant pairs were categorized at high risk and the weaning rate in this subgroup was 5%. The mother-infant pairs with a score lower than 8 had a shorter median breastfeeding duration (18 versus 20 weeks, P=0.02), were more likely to report breastfeeding difficulties after discharge (63% versus 53%, P=0.03), and were less likely to be "very satisfied" with breastfeeding experience (66% versus 77%, P=0.007). CONCLUSION: The intrinsic properties of the BAS are robust. However, its use would be of limited interest in France because of the relatively low rate of early weaning. Randomized trials are needed before recommending routine use of BAS-based breastfeeding support intervention.

[Oxytocin and maternal stress during the post-partum period]. / Ocytocine et stress de la mère au cours de la lactation en post-partum. L'ocytocine est-elle impliquée dans la confiance en soi de la mère allaitante? Revue de la littérature.

Oxytocin is required for lactation by promoting milk expulsion. Oxytocin has also been reported to exert a positive role in social attachment. The postpartum period has been shown to be crucial for maternal behavior initiation, and required self-trust reinforcement. However, this period is also remarkable for the high risk exposure of either psychic or physical stress. A negative impact on young mother is suspected, both in the short, medium or long term, which can even be deleterious for child-mother relationships. During lactation in female rats and sheep, oxytocin production has been proved to decrease stress-induced hormonal changes and later consequences. In human beings, only the first hour after breast-feeding seems to protect against physical or psychic stress. Oxytocin improves the stress-induced response by reducing the ACTH and cortisol secretion thus representing a potential therapeutic pathway in post-partum pathologies such as depression. Thus, this review of recent literature about oxytocin and stress during post-partum period, leads to the assumption that oxytocin, at the moment of installation of breastfeeding, acts not only on the physiological condition, but also on the psychic condition of the mother.

[Initiation and duration of breastfeeding in obstetrical hospitals of Aix-Chambery (France)]. / Initiation et durée de l'allaitement maternel dans les établissements d'Aix et Chambéry (France).

UNLABELLED: Our objectives were to estimate duration of breastfeeding and to identify factors associated with initiation and weaning. METHODS: A prospective study was carried out among 353 mothers delivering in three obstetric hospitals at Aix-Chambery (Savoie, France). Breastfeeding was considered as survival data with censored observations. Univariate and multivariate analyses were performed. RESULTS: Breastfeeding was initiated by 70.8% (66.1-75.5) (exclusive breastfeeding = 39.9% and complementary breastfeeding = 30.9%). Respectively, 58.1% (52.9-63.3) and 12.2% (8.3-16.1) were continuing some breastfeeding at one and six months. The median duration of breastfeeding was 13 weeks (11.6-14.4). Shorter duration was associated with contact beyond one hour from birth (adjusted Hazard Ratio [aHR] = 1.25 [1.03-1.52] and with contact beyond eight hours aHR = 1.78 [1.66-1.92]), pacifier use (aHR = 1.72 [1.19-2.47]), breastfeeding at fixed hours (aHR = 1.78 [1.29-2.45]), and decision to breastfeed during pregnancy or the postpartum period (aHR = 1.70 [1.45-2.00]). CONCLUSION: Breastfeeding initiation and duration were higher in maternity hospitals of Chambéry than estimations measured in the 1998 French perinatal survey and in other ad hoc surveys. Identified factors should be used in order to plan future programs designed to increase duration of breastfeeding.