Reasons for Stopping Exclusive Breastfeeding Between Three and Six Months: A Qualitative Study.

PURPOSE: Scant published qualitative literature exists focusing on why exclusive breastfeeding rates decline between three and six months. This study aims to develop an understanding of why exclusive breastfeeding tails off so dramatically between three and six months after birth in New Zealand. DESIGN AND METHODS: A generic qualitative methodology was employed in this study and social constructionism selected as the main epistemological framework underpinning the research. This study was carried out between September 2013 and July 2014, involving face-to-face interviews with 30 women who were characterised as highly motivated to complete six months exclusive breastfeeding prior to the birth of their child. In order to gain an in-depth understanding of the research material, thematic analysis of the interview transcripts was completed using manual coding techniques. RESULTS: After thematic analysis of the data four key themes were identified: 1) The good employee/good mother dilemma. 2) Breastfeeding is lovely, but six months exclusively is demanding. 3) Exclusive breastfeeding recommendations should be individualised. 4) Introducing solids early as a cultural practice. CONCLUSIONS: Most studies have linked barriers to six months exclusive breastfeeding to difficulties within the mother-infant dyad, as well as negative maternal socioeconomic and socio-demographic characteristics. However, this study has shown that the maintenance of six months exclusive breastfeeding is also challenging for this group of mothers who were socially advantaged, well-educated and highly motivated to breastfeed their babies exclusively for six months.

New Zealand women talk about breastfeeding support from male family members.

AIM: Little research has been done to investigate the influence of male family members' support for breastfeeding. This article considers the influence of male partners and other male family members on the initiation and duration of exclusive breastfeeding. METHODS: Thirty heterosexual New Zealand women who had identified in a short antenatal questionnaire that they intended to breastfeed exclusively for 6 months were recruited. The qualitative research included a face-to-face postpartum interview followed by monthly audio-recorded telephone interviews that stopped at 6 months. The participants' narratives were analysed using thematic analysis. KEY FINDINGS: Five key themes related to breastfeeding support from male family members were identified: a) male partners did not have enough knowledge about breastfeeding, b) male partners wanted to share infant feeding, c) participants received emotional and practical support from their male partners, d) male partners supported breastfeeding in public, e) some women received crucial breastfeeding support from male family members who were not the father of the baby. CONCLUSION: Comments from participants suggest that some New Zealand men are actively involved in supporting breastfeeding in their nuclear and extended families. Several participants suggested that male support was as effective as support from female family members.

Risk of severe postpartum hemorrhage in low-risk childbearing women in new zealand: exploring the effect of place of birth and comparing third stage management of labor.

BACKGROUND: Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationally. Research comparing physiological (expectant) and active management of the third stage of labor favors active management, although studies to date have focused on childbirth within hospital settings, and the skill levels of birth attendants in facilitating physiological third stage of labor have been questioned. The aim of this study was to investigate the effect of place of birth on the risk of postpartum hemorrhage and the effect of mode of management of the third stage of labor on severe postpartum hemorrhage. METHODS: Data for 16,210 low-risk women giving birth in 2006 and 2007 were extracted from the New Zealand College of Midwives research database. Modes of third stage management and volume of blood lost were compared with results adjusted for age, parity, ethnicity, smoking, length of labor, mode of birth, episiotomy, perineal trauma, and newborn birthweight greater than 4,000 g. RESULTS: In total, 1.32 percent of this low-risk cohort experienced an estimated blood loss greater than 1,000 mL. Place of birth was not found to be associated with risk of blood loss greater than 1,000 mL. More women experienced blood loss greater than 1,000 mL in the active management of labor group for all planned birth places. In this low-risk cohort, those women receiving active management of third stage of labor had a twofold risk (RR: 2.12, 95% CI: 1.39-3.22) of losing more than 1,000 mL blood compared with those expelling their placenta physiologically. CONCLUSIONS: Planned place of birth does not influence the risk of blood loss greater than 1,000 mL. In this low-risk group active management of labor was associated with a twofold increase in blood loss greater than 1,000 mL compared with physiological management. (BIRTH 39:2 June 2012).

Iodine-only supplements for breastfeeding women: a call to action in New Zealand.

Nil.

Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women?

BACKGROUND: Midwives providing care as lead maternity caregivers in New Zealand provide continuity of care to women who may give birth in a variety of settings, including home, primary units, and secondary and tertiary level hospitals. The purpose of this study was to compare mode of birth and intrapartum intervention rates for low-risk women planning to give birth in these settings under the care of midwives. METHODS: Data for a cohort of low-risk women giving birth in 2006 and 2007 were extracted from the Midwifery Maternity Provider Organisation database. Mode of birth, intrapartum interventions, and neonatal outcomes were compared with results adjusted for age, parity, ethnicity, and smoking. RESULTS: Women planning to give birth in secondary and tertiary hospitals had a higher risk of cesarean section, assisted modes of birth, and intrapartum interventions than similar women planning to give birth at home and in primary units. The risk of emergency cesarean section for women planning to give birth in a tertiary unit was 4.62 (95% CI: 3.66-5.84) times that of a woman planning to give birth in a primary unit. Newborns of women planning to give birth in secondary and tertiary hospitals also had a higher risk of admission to a neonatal intensive care unit (RR: 1.40, 95% CI: 1.05-1.87; RR: 1.78, 95% CI: 1.31-2.42) than women planning to give birth in a primary unit. CONCLUSIONS: Planned place of birth has a significant influence on mode of birth and rates of intrapartum intervention in childbirth.

Use of Iodine Supplements by Breastfeeding Mothers Is Associated with Better Maternal and Infant Iodine Status.

Adequate iodine status during conception, pregnancy and lactation is essential for supporting infant neurodevelopment. Iodine status in adults and children was improved after two New Zealand government initiatives, but the status of breastfeeding women is unknown. This study aimed to investigate the iodine intake and status of lactating mother-infant pairs at 3 months postpartum and to assess maternal iodine knowledge and practice. Iodine intake was estimated by a weighed 4-day diet diary (4DDD). Maternal urinary iodine concentrations (UIC) in spot urine, breast milk iodine concentrations (BMIC) and infant UIC were measured. Questions about iodine-specific knowledge and practice were asked. In 87 breastfeeding mother-infant pairs, maternal iodine intake was 151 (99, 285) µg/day, and 58% had an intake below the estimated average requirement (EAR) of 190 µg/day. Maternal median UIC (MUIC) was 82 (46, 157) µg/L indicating iodine deficiency (i.e., < 100 µg/L). Women who used iodine-containing supplements had a significantly higher MUIC (111 vs 68 µg/L, P = 0.023) and BMIC (84 vs 62 µg/L, P < 0.001) than non-users. Infants fed by women using iodine-containing supplements had a higher MUIC (150 vs 86 µg/L, P = 0.036) than those of non-users. A total of 66% (57/87) of women had no or low iodine knowledge. The iodine knowledge score was a statistically significant predictor of consuming iodine-containing supplements [(beta = 1.321, P = 0.008)]. Despite a decade of initiatives to increase iodine intakes in New Zealand, iodine knowledge was low; iodine intake and status of these lactating women were suboptimal, but women who used iodine-containing supplement were more likely to achieve adequate status.Study Registration Number (Australia and New Zealand Clinical Trials Registry): ACTRN12615001028594.

Mother and Infant Nutrition Investigation in New Zealand (MINI Project): Protocol for an Observational Longitudinal Cohort Study.

BACKGROUND: Thyroid dysfunction is associated with cognitive impairment, mood disturbance, and postnatal depression. Sufficient thyroid hormone synthesis requires adequate intake of iodine, selenium, and iron. Iodine deficiency was historically a problem for New Zealand, and initiatives were introduced to overcome the problem: (1) mandatory fortification of all bread (except organic) with iodized salt (2009) and (2) provision of subsidized iodine supplements for pregnant and breastfeeding women (2010). Subsequent to these initiatives, most adults and children have adequate iodine status; however, status among breastfeeding women and their infants remains unclear. This paper outlines the methodology of the Mother and Infant Nutrition Investigation (MINI) study: an observational longitudinal cohort study of breastfeeding women and their infants. OBJECTIVE: This study will determine (1) women's iodine intake and status among supplement users and nonusers; (2) women's intake and status of iodine, selenium, and iron relating to thyroid function; (3) associations between women's selenium status, thyroid function, and postnatal depression; (4) infants' iodine and selenium status relating to first year neurodevelopment. METHODS: Breastfeeding women aged over 16 years with a healthy term singleton infant were recruited from Manawatu, New Zealand. Participants attended study visits 3, 6, and 12 months postpartum. Maternal questionnaires investigated supplement use before and after birth, iodine knowledge, and demographic information. Dietary assessment and urine, blood, and breast milk samples were taken to measure iodine, selenium, and iron intake/status. The Edinburgh Postnatal Depression Scale was used repeatedly to screen for postnatal depression. Thyroid hormones (free triiodothyronine, free thyroxine, thyroid stimulating hormone, thyroglobulin, antithyroglobulin antibodies, and antithyroid peroxidase) were measured in blood samples, and thyroid gland volume was measured by ultrasound at 6 months postpartum. Infant iodine and selenium concentrations were determined in urine. The Ages and Stages Questionnaire was used to assess infant development at 4, 8, and 12 months. RESULTS: Data collection was completed. Biological samples analysis, excluding nail clippings, is complete. Data analysis and presentation of the results will be available after 2020. CONCLUSIONS: This study will provide data on the current iodine status of breastfeeding women. It will also provide a greater understanding of the three essential minerals required for optimal thyroid function among breastfeeding women. The prospective longitudinal design allows opportunities to examine women's mental health and infant neurodevelopment throughout the first year, a crucial time for both mothers and their infants. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615001028594; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369324. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18560.

Inherited understandings: the breast as object.

This paper discusses findings from a research study that investigated the experience of being a breastfeeding woman in New Zealand. The study was motivated by a desire to better understand why the majority of New Zealand women wean their infants before 6 months of age, despite the benefits of prolonged breastfeeding being well accepted. Nineteen women, who were breastfeeding or had recently breastfed, were engaged in unstructured interviews about their experience, and the results were examined using a reflective lifeworld research methodology. The findings presented here demonstrate that women often employ an interpretive framework that is aligned with the philosophical tradition of Descartes' mind-body split, also know as Cartesian dualism. This leads to a widely held perception of the breast as an object, which emerged in the participants' narratives and is explored using Heidegger's philosophical interpretation of equipment. We conclude that the objectification of the breast in our society fails to provide women with language that describes the breastfeeding experience in a meaningful way, thus undermining women's ability to articulate and reconcile their embodied breastfeeding experiences.

"I did a lot of Googling": A qualitative study of exclusive breastfeeding support through social media.

BACKGROUND: Little qualitative research has been done to explore the quality of breastfeeding support through social media in New Zealand. AIM: This article aims to explore the influence of social media on exclusive breastfeeding practice. METHODS: A qualitative study involving face-to-face postpartum interviews with 30 mothers who were recruited from the lower North Island of New Zealand. Each participant was followed via short monthly audio-recorded telephone interviews until giving up exclusive breastfeeding or until six months after the birth. The theories "strength of weak ties" and "landscapes of care" are applied to the thematic analysis of the interview material to illuminate the influence of social media on breastfeeding practices. RESULTS: Qualitative analysis of the interview material identified four themes: 1) Mothers need reliable online infant feeding information; 2) Smartphone apps can be a good option for promoting breastfeeding; 3) Information is accessed through weak ties among breastfeeding mothers on Facebook, and 4) the utility of geographically distant infant feeding support via Skype. DISCUSSION: Most participants sourced post-partum information and advice to support breastfeeding through the Internet, while those with geographically distant family members accessed emotional and practical breastfeeding support via Skype. IMPLICATIONS FOR PRACTICE: Breastfeeding advocates should use social media to promote and support exclusive breast-feeding practice. CONCLUSION: The influence of social media on breastfeeding points to the relational nature of breastfeeding which is embedded in 'real' world and virtual social networks as well as the cultural, geographic and social contexts of a mother's life.

Resistance to breastfeeding: A Foucauldian analysis of breastfeeding support from health professionals.

BACKGROUND: Despite widespread consensus regarding the health benefits of breastfeeding, the prevalence of six months exclusive breastfeeding is very low in developed countries including New Zealand. AIM: This paper aims to evaluate the role that health professionals play in promoting exclusive breastfeeding in New Zealand. METHODS: Qualitative research involving face to face postpartum interviews conducted four to six weeks after the birth with 30 new mothers who lived in New Zealand and had identified in a short antenatal questionnaire that they intended to practice exclusive breastfeeding for six months. Themes related to exclusive breastfeeding support from health professionals were extracted from the interview transcripts and interpreted using Foucault's ideas about governmentality and bio-power. RESULTS: Four themes related to the quality of health care support were identified in the interview transcripts. 'Breastfeeding self-efficacy support from the community midwives', 'mothers need to know more about breastfeeding during pregnancy', 'experiencing difficulties breastfeeding' as well as 'pressure and resistance to breastfeeding'. DISCUSSION: Most mothers in this research spoke about feeling pressured to breastfeed within the New Zealand health system. However, the participating mothers acknowledged the effective support that they had received from community midwives who respected their autonomy, strengthened their self-esteem and encouraged them to breastfeed. CONCLUSION: Negative historical experiences related to the medicalization of infant feeding in Western countries suggests that health professionals need to provide effective skill support for breastfeeding mothers so that mothers do not consider it a form of "quiet coercion" or as an exercise of "power".

Thermal characteristics of Metarhizium anisopliae isolates important for the development of biological pesticides for the control of cattle ticks.

Experiments were conducted to determine if Metarhizium anisopliae isolates which are capable of growth at cattle surface temperatures could produce pathogenicity to Boophilus microplus in laboratory and field studies. The diurnal temperature fluctuation on the surface of cattle was monitored. The temperature tolerance of M. anisopliae isolates (ARSEF3297 and IMI386697) was determined and their pathogenicity to B. microplus compared at a standard bioassay temperature (28 degrees C) and at a temperature similar to the cattle surface (31-35 degrees C). The effect of the two isolates on the B. microplus population on cattle under field conditions was determined. The temperature of the fore udder, rear udder, ribs and neck regions of the mixed Holstein cattle fluctuated between 30 and 35 degrees C, in a similar pattern to the prevailing environmental temperature. However, wider fluctuations were obtained on the ears (28-35 degrees C) and spine (30-41 degrees C). The colony radius of both isolates declined as temperature increased, however, the growth of IMI386697 was five times greater than ARSEF3297 at 34 degrees C. At 28 degrees C, the pathogenicity of both isolates to B. microplus was similar, however, at 31-35 degrees C, IMI386697 was more pathogenic than ARSEF3297. Both isolates reduced the B. microplus population on cattle in comparison to the control formulation. However, IMI386697 (8.5+/-0.64 ticks/animal) produced a greater reduction in tick numbers than ARSEF3297 (19.1+/-0.64 ticks/animal). M. anisopliae was re-isolated from 8.9% of the ticks collected from IMI386697 treated cattle as compared to 2.8% of ticks from ARSEF3297 treated cattle.

The midwife's role in facilitating smoking behaviour change during pregnancy.

OBJECTIVE: To explore the midwife's role in providing education and support for changes in smoking behaviour during usual primary maternity care. DESIGN: A qualitative study using a thematic approach to analysis of data collected in face-to-face interviews. SETTING AND PARTICIPANTS: Eleven women who had participated in the intervention groups of the MEWS Study, a cluster randomised trial of education and support for women who smoke, and 16 midwives from the intervention and control arms of the trial. The trial was set in the lower North Island of New Zealand in 2000. FINDINGS: Midwives acknowledged that asking women about smoking was part of their role as maternity care providers. However, many found it difficult to know how to ask women about their smoking, how to identify the women who would be receptive to advice and how to support them to make changes to their smoking. Midwives were also concerned about making women feel guiltier than they already did about their smoking, and about the impact of providing smoking cessation on their relationship with women. In contrast, women expected their midwife to ask them about their smoking. When women wanted to quit their midwife was an extremely valuable source of information and support. Midwives were also in a position to help women who did not want to quit to make other changes to their smoking behaviour. Even women who did not want to quit were prepared to be asked about their smoking. Problems arose when the way the midwife asked and the frequency of her enquiries were not appropriate for the stage of the change cycle the woman was in. IMPLICATIONS FOR PRACTICE: Midwives can effectively provide education and support for smoking change during pregnancy if they match the woman's readiness to make changes with the type of advice and support they provide.

Can support and education for smoking cessation and reduction be provided effectively by midwives within primary maternity care?

OBJECTIVE: To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care, can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding. DESIGN, SETTING AND PARTICIPANTS: In a cluster randomised trial of smoking education and breast-feeding interventions in the lower North Island, New Zealand, midwives were stratified by locality and randomly allocated into a control group and three intervention groups. The control group provided usual care. Midwives in the intervention groups delivered either a programme of education and support for smoking cessation or reduction, a programme of education and support for breast feeding or both programmes. Sixty-one midwives recruited a total of 297 women. INTERVENTIONS: Structured programmes provided by midwives. FINDINGS: Women receiving only the smoking cessation or reduction programme were significantly more likely to have reduced, stopped smoking or maintained smoking changes than women in the control group, at 28 weeks and 36 weeks gestation. Women receiving both the smoking cessation and breast-feeding education and support programmes were significantly more likely than women in the control group to have changed their smoking behaviour at 36 weeks gestation. There was no difference in rates of cessation or reduction between the groups in the postnatal period. There was no difference in rates of full breast feeding between the control and intervention groups for women who planned to breast feed. KEY CONCLUSIONS: Education and support by midwives, as part of primary midwifery, can facilitate smoking cessation and reduction during pregnancy.

Smoking cessation and nicotine replacement therapy in current primary maternity care.

AIM: To determine attitudes, activity and confidence among general practitioners and midwives about smoking cessation practice, and use of nicotine replacement therapy (NRT) during pregnancy and breastfeeding. METHOD: A postal survey of 780 New Zealand health professionals providing maternity care. RESULTS: 274 GPs (82 practising obstetrics) and 184 midwives responded (RR: 64%), with most (88% GPs, 77% midwives) regarding providing smoking cessation advice integral to their job. Only about half gave smoking cessation advice to most pregnant women who smoked. They were uncertain about the safety of NRT use in pregnant and breastfeeding women. Most respondents requested more information about NRT use. DISCUSSION: Smoking cessation practice falls short of respondents' beliefs about good practice and current recommendations.

Towards a relational model of decision-making in midwifery care.

OBJECTIVE: current individualistic ideas of autonomy and decision making do not fit within the context of decision-making in the midwife-woman relationship. This article critically explores current issues around decision-making and proposes a relational decision-making model for midwifery care. DESIGN: qualitative prenatal and postnatal interviews around decision-making within childbirth in general, and the third stage of labour in particular. PARTICIPANTS: eight midwife-woman pairs in urban settings in New Zealand. FINDINGS: a range of relational, social and political factors that are not present within existing decision-making models were highlighted. The themes included ontological and philosophical influences on decision-making; uncertainty, vulnerability and relational trust; and socio-political and cultural influences. Inconsistencies in knowledge arising from social, cultural and familial considerations as well as identities, beliefs, values, conversations, and practices were found to produce uncertainties around potential courses of action, expected consequences and outcomes. 'Unplanned' birth experiences decreased client autonomy and increased vulnerability thereby intensifying relational trust within decision-making. The political context may also open up or close down possibilities for decision-making at both national and local levels. CONCLUSION: decision-making for women and midwives is influenced by complex human, contextual and political factors. This study supports a relational model of decision-making that is embedded in understandings of choice as 'entangled'. A relational model enables consideration of how factors such as identity projects, individual practices, the organisation of maternity care, local hospital cultures, medicalised childbirth, workforce shortages, funding cuts and poverty shape the way in which care decisions are made.

Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy.

This study describes the development and evaluation of education programmes and associated resource materials to support smoking cessation and reduction, and breastfeeding promotion strategies for pregnant women who smoke, during usual primary maternity care by midwives. Education programmes and resource materials were developed by midwives and researchers as part of a cluster randomized trial of Midwifery Education for Women who Smoke (the MEWS study). Development included a cohort study, advice from lactation consultants and smoking cessation counsellors (including Ma-ori professionals), and early consultation with midwives who would be delivering the programmes. Resources developed included videotapes, charts and laminated information cards. Resources were pre-tested with pregnant women and opinion leaders. Consultation with the midwives allocated to each of the intervention groups in the trial raised a number of issues. These were addressed, and solutions incorporated into each of the programmes, to enable effective delivery within usual care. Following delivery of the programmes, women and their midwives were surveyed and a sample interviewed to ascertain attitudes to the programmes and resources. Women and their midwives responded positively to the smoking cessation education programme, the breastfeeding promotion programme and the resources used. Those women who did not stop smoking completely often succeeded in significantly reducing their tobacco consumption. Women identified their midwife as a valuable resource and appreciated her ongoing encouragement. Involvement of health professionals who are to deliver health promotion interventions is essential for successful integration of programmes into usual care. Midwives were able to effectively deliver programmes that were developed and targeted to their needs as health educators. The pregnancy-specific resources developed for women who smoke played an important part in helping midwives deliver their health promotion messages more effectively.