How Does the United States Rank According to the World Breastfeeding Trends Initiative?

The World Breastfeeding Trends Initiative is an assessment process designed to facilitate an ongoing national appraisal of progress toward the goals of the United Nations Children's Fund (UNICEF)/World Health Organization (WHO) Global Strategy for Infant and Young Child Feeding. More than 80 countries have completed this national assessment, including the United States of America. This article describes the process undertaken by the US World Breastfeeding Trends Initiative team, the findings of the expert panel related to infant and young child feeding policies, programs, and practices and the ranking of the United States compared with the 83 other participating nations. Identified strengths of the United States include data collection and monitoring, especially by the Centers for Disease Control and Prevention, the US Baby-Friendly Hospital Initiative, and the United States Breastfeeding Committee. The absence of a national infant feeding policy, insufficient maternity protection, and lack of preparation for infant and young children feeding in emergencies are key targets identified by the assessment requiring concerted national effort.

Evaluation of mothers' knowledge, attitudes, and practice towards the ten steps to successful breastfeeding in Egypt.

BACKGROUND: Despite the proven effectiveness of the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative (BFHI), its impact on community practices in Egypt has yet to be assessed. The aim of this investigation was to evaluate the knowledge, attitudes, and practice (KAP) of Egyptian mothers towards the Ten Steps. We interviewed 1,052 breastfeeding mothers with infants less than 24 months of age from 12 governorates representing Upper Egypt (UE) and Lower Egypt (LE). RESULTS: Marked regional variations are noted in the KAP of the samples from UE and LE. These differences can be explained to some extent by socioeconomic factors. Hospital delivery, lower parity, and a higher level of education were characteristic of mothers in LE compared with UE. More mothers in UE did not know about the protective effects of breastfeeding to the mother. In LE, 75% delayed breastfeeding initiation until after the first hour compared with 61% in UE, with the mothers reporting that they did not experience skin-to-skin care in the first hours after birth. Nipple pain was given as a cause for supplementation in 56% of mothers in UE and 36% in LE (p<0.001). Maintaining milk by expression is practiced by 42.8% of mothers in LE and 12% in UE. Two-thirds of the mothers in both UE and LE offer herbal drinks, and one-third feed infant milk formula before 6 months. Offering pacifiers is more common in LE, and feeding by bottle is more common in UE, being pressured by the mother's social network. CONCLUSIONS: To increase the impact of BFHI on community breastfeeding practices, BFHI should focus on involving the family members with the mother throughout the implementation of the Ten Steps while encouraging maternal support groups and taking cultural differences into account.

A Realistic Evaluation of Two Training Programs on Implementing Skin-to-Skin as a Standard of Care.

The authors used realistic evaluation to examine the real-world effectiveness of two 5-day training techniques on sustained optimal skin-to-skin practices that support Step 4 of the revised Baby-Friendly Hospital Initiative (BFHI). The authors found that education alone was insufficient to effect sustainable practice change. Exposure to the 5-day immersion model (Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success, or PRECESS) alone or combined with education was an effective strategy to change and sustain the standard of care for skin-to-skin practice (p < 0.00001). The intended outcome of sustained practice change toward implementation of skin-to-skin care through immersion or a combined approach shows promise and should be repeated in other localities.

Lactation resources for clinicians.

Breastfeeding is widely acknowledged as the optimal infant feeding choice. However, many clinicians working in maternal and child health do not receive adequate university preparation to support breastfeeding. Knowledge and skill are most often gained through on-the-job and personal experience. Myriad resources exist to support clinicians in delivering the best quality care to breastfeeding clients. Among the available resources are policies and protocols of professional organizations, governmental, and health advocacy groups. Breastfeeding-focused academic and continuing education programs are identified. Electronic and other resources for breastfeeding information are available for both professional and consumer audiences.

Pain reduction and treatment of sore nipples in nursing mothers.

Health-promotion goals include increasing the duration of breastfeeding because of its irrefutable advantages to the mother and baby, society, and the environment. However, many mothers experience painful, sore nipples during breastfeeding and stop nursing before they intended (Livingstone & Stringer, 1999). The experimental trial described in this paper randomized 94 breastfeeding women with sore nipples into three treatment groups. Midwives practicing in hospitals in Latvia assessed the participants' breastfeeding practices, then gave the mothers individualized education and corrective interventions using a guided documentation form, the Lactation Assessment Tool (LATtrade mark). In addition, two groups were instructed to use commercial products on their breasts and nipples: breast shells and lanolin cream for one group, and glycerin gel therapy for the other. Nipple pain during breastfeeding was rated by the mothers on a 5-point verbal descriptor scale at each visit, and pain at the start of treatment was compared to pain at the last visit. Analysis of variance (using Fisher's Exact Test) determined that no significant differences existed between the groups: F(2, 86) = 1.34, p > .05. Almost all of the mothers experienced nipple healing, as assessed by the midwife. Mothers in the glycerin gel group were more satisfied with their treatment method, but this finding was not statistically significant. The results of this study indicate that effective care and perinatal education for nursing mothers with sore nipples should include assessment of breastfeeding positioning and latch-on, as well as education and corrective interventions using a guidance tool, whether or not commercial preparations are used.