Psychosocial dimensions of human milk sharing.

Breastfeeding is critical to maternal and infant health. Psychosocial factors are associated with lactation outcomes, and perinatal mood disorders (PMDs) are often linked with breastfeeding difficulties and early, unexpected weaning. Parents may utilize human milk sharing to ensure their infant receives human milk when breastfeeding requires supplementation or is not possible, but this practice carries health risks and is often stigmatized. Milk sharing recipient mothers may be particularly vulnerable to PMDs associated with breastfeeding difficulties. The study objective was to explore factors associated with emotional responses to a parent's decision to feed their infant with shared human milk. An online cross-sectional survey of 205 milk sharing recipients was analysed with linear regression. Controlling for participants' education and breastfeeding difficulties, higher perceived social stigma was associated with more negative emotional responses (p < .01). Receiving strong spousal/partner support for milk sharing (p < .001) and screening donors regarding the health of their nursling(s) (p < .05) were associated with more positive emotional responses. Social stigmatization of milk sharing may negatively influence emotional responses among recipient mothers. Based on these results, it can be recommended that health professionals screen breastfeeding mothers with lactation difficulties for emotional distress that may lead to PMDs and provide evidence-based information about milk sharing in a nonstigmatizing way. Health professionals may support informed decision-making for infant feeding practices, including human milk sharing, by providing information on milk sharing risks and risk mitigation, developing evidence-based practices and guidelines that facilitate safe milk sharing, and directing families to available resources for psychosocial support.

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation.

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Rusty pipe syndrome: counselling a key intervention.

Presence of blood in the breastmilk renders a rusty or brownish colour to it; this entity is known as "rusty pipe syndrome". Although this is a self-limiting condition, it can be particularly intimidating for mothers and may act as a psychological barrier to successful breastfeeding. We describe this entity in two mothers who had spontaneous blood-stained breastmilk from both breasts in the early post-partum period and were worried about feeding their infants. Subsequent to proper counselling with the use of skills like active listening, accepting their concerns, building confidence by providing relevant information in simple language and by giving suggestions and avoiding commands, both mothers were able to successfully breastfeed their offspring.

Risk factors for early lactation problems among Peruvian primiparous mothers.

The aim of this study was to determine the incidence and risk factors for early lactation problems [suboptimal infant breastfeeding behaviour (SIBB), delayed onset of lactogenesis (OL) and excessive neonatal weight loss] among mother-infant pairs in Lima, Peru. All primiparous mothers who gave birth to a healthy, single, term infant at a government hospital in a peri-urban area of Lima during the 8-month recruitment period were invited to participate in the study. Data were collected at the hospital (day 0) and during a home visit (day 3). Infant breastfeeding behaviour was evaluated using the Infant Breastfeeding Assessment Tool; SIBB was defined as < or = 10 score. OL was determined by maternal report of breast fullness changes; delayed OL was defined as perceived after 72 h. Excessive neonatal weight loss was defined as > or = 10% of birthweight by day 3. One hundred seventy-one mother-infant pairs participated in the study. SIBB prevalence was 52% on day 0 and 21% on day 3; it was associated with male infant gender (day 0), < 8 breastfeeds during the first 24 h (days 0 and 3), and gestational age < 39 weeks (day 3). Delayed OL incidence was 17% and was associated with infant Apgar score < 8. Excessive neonatal weight loss occurred in 10% of neonates and was associated with maternal overweight and Caesarean-section delivery. Early lactation problems may be influenced by modifiable factors such as delivery mode and breastfeeding frequency. Infant status at birth and maternal characteristics could indicate when breastfeeding dyads need extra support.

[Impact of stressful life event, weight gain during pregnancy and mode of delivery on the delayed onset of lactation in primiparas].

OBJECTIVE: To evaluate the effect of severe life events at first, second and third trimester, excessive weight gain during pregnancy and caesarean section on the delayed onset of lactation. METHODS: The effect of life stressful event during different gestational age in a total of 2017 parturient women giving birth in hospitals was assessed with reliable questionnaires. Demographic characteristics, history of pregnancy, BMI at early pregnancy and antepartum and the delivery outcomes including gestational age at birth, mode of delivery and the condition of babies were collected by interviewing or from medical charts. Lactation guidance was provided and the data on the onset of lactation were collected in hospitals within 72 hours after parturition. The onset of lactation was defined by the perception of mothers on the fullness of the breast. Univariate and multivariate logistic regression analyses were performed after controlling maternal age, registered permanent residency and educational level. RESULTS: Delayed onset of lactation occurred in 9.5% of 2017 women and was associated with exposure to severe life events at the first trimester (crude RR = 1.72, 95% CI 0.97 - 3.04, adjusted RR = 1.97, 95% CI 1.09 - 3.55) , increasing of BMI > or = 7.6 during pregnancy (crude RR = 1.93, 95% CI 1.23 - 2.94, adjusted RR = 1.64, 95% CI 1.07 - 2.54) and caesarean section (crude RR = 1.35, 95% CI 1.20 - 1.53, adjusted RR = 1.32, 95% CI 1.17 - 1.49). CONCLUSION: Success on early lactation is strongly influenced by potentially modifiable factors, such as exposure to severe life events in the first gestational age, excessive weight gain during pregnancy and caesarean section.

Understanding the Challenges of Induction of Lactation and Relactation for Non-Gestating Spanish Mothers.

BACKGROUND: Induced lactation and relactation are the processes that enable breastfeeding in non-gestating mothers. RESEARCH AIM: The aim of this study was to describe and interpret the challenges faced by mothers who undergo induced breastfeeding and relactation for adopted infants, infants born via surrogacy, and infants born to same-sex female partners. METHODS: A qualitative study was performed using in-depth interviews conducted with Spanish women (N = 9) who had decided to undergo induced lactation or relactation. The data were collected between October 2014 and May 2017. The length of the study was due to the difficulty in locating and recruiting the sample. Interviews were transcribed and coded with the ATLAS.ti v.7.5.7 software. We performed a deductive thematic analysis, creating categories based on the interview questions, which we developed on the basis of previous literature about induced lactation and relactation. RESULTS: Participants described the following challenges: the physical hardships of the process; breastfeeding problems; difficulty with accessing information about induced lactation or relactation; and lack of support from health professionals. Breastfeeding periods lasted from 1.5 months to 4 years. Participants reported that breastfeeding increased the closeness between the mother and child and that this feeling of closeness tended to decrease after breastfeeding cessation. CONCLUSION: We offer data and analysis that can improve our understanding of the lived experiences of women undergoing the process of relactation or induced lactation and may help guide intervention strategies to support women in this situation.

Caring for Women Experiencing Breast Engorgement: A Case Report.

Breast engorgement is an uncomfortable and sometimes painful component of the postpartum period. The effective treatment of breast engorgement may provide an avenue for clinicians to improve postpartum care for women and promote breastfeeding. This case report presents one woman's experience with breast engorgement in the early postpartum period. The etiology, evidence-based practices for treatment, clinical implications, and recommendations for practice are reviewed. The importance of interprofessional care to minimize conflicting information a lactating woman receives is highlighted. Interprofessional teamwork can optimize care to resolve breast engorgement and facilitate a woman achieving her breastfeeding goals.

Failure to lactate: a possible late effect of cranial radiation.

We conducted a retrospective review of the lactation experience of female survivors who received 24 Gy cranial radiotherapy as CNS prophylaxis for acute lymphoblastic leukemia in childhood prior to 1982 and who attend the Long-Term Follow-Up Clinic at Sydney Children's Hospital, Randwick, Australia. Median time since diagnosis is 28 years (range 25-37 years). Twelve have produced offspring. Ten report minimal or no breast changes during pregnancy and failure to lactate postpartum. All patients remain in remission. These data suggest a high risk of failure of lactation in women treated during childhood with 24 Gy cranial irradiation. Awareness of this possibility can assist in counseling.

Supporting breastfeeding mothers in hospital: part 2a.

The first article in this series highlighted the challenges that mothers face in establishing breastfeeding (Wallis and Harper 2007). Breastfeeding a sick infant in hospital presents additional challenges such as small, sleepy babies, babies who may be nil by mouth for prolonged periods and babies who may find breastfeeding difficult due to mechanical problems. There is very little published abut the needs of babies with complex medical or surgical conditions who may have had significant delays in their feeding or numerous starts and stops along the way. This article and Part 2b in the November issue illustrate some of the common challenges and propose principles of care that are transferable to caring for other sick babies with similar problems.

Association Between Gestational Weight Gain and Delayed Onset of Lactation: The Moderating Effects of Race/Ethnicity.

BACKGROUND: In the United States, a high percentage of pregnant women gain weight outside of the current Institute of Medicine's (IOM) gestational weight gain (GWG) recommendations. There is limited research examining the relationship between GWG and onset of lactation. Delayed onset of lactation (DOL) can negatively affect breastfeeding outcomes. METHODS: Secondary data analysis was conducted using data from 2,053 women who participated in the population-based Infant Feeding Practices Study II between 2005 and 2007. The main outcome of interest was maternal perception of DOL, defined as milk coming in >3 days postpartum. Three categories of GWG were created based on the IOM's revised cutoff: inadequate, adequate, and excessive. Descriptive statistics and multivariable logistic regression modeling were performed. Interactions between GWG and race/ethnicity on DOL were examined to test whether the relationship between GWG and DOL differs by race/ethnicity. RESULTS: Overall, 23.7% of the study sample reported DOL. Of these, 49.5% and 19.5% of women had excessive GWG and inadequate GWG, respectively. After adjusting for potential confounders, there was a significant interaction between GWG and race/ethnicity on DOL. Among non-Hispanic white women, the odds of DOL were higher in women with excessive GWG compared to those who had the recommended GWG (OR 1.47, 95% CI 1.14-1.90, p = 0.003). For other race/ethnicity groups, no significant relationships between GWG and DOL were detected. CONCLUSIONS: With the increasing rates of excessive GWG, it is critical to identify populations at increased risk of DOL and provide targeted breastfeeding support, especially in the early postpartum period.

After Chemotherapy Treatment for Maternal Cancer During Pregnancy, Is Breastfeeding Possible?

OBJECTIVE: To report breastfeeding complaints of women diagnosed with cancer during pregnancy and correlate success with characteristics of their treatment. MATERIALS AND METHODS: This is a prospective cohort study of women diagnosed with cancer during pregnancy who attempted breastfeeding. We surveyed participants about breast engorgement, milk let down, and consistent breast milk production through mailed questionnaires. Treatment details, including the type and number of chemotherapy cycles given during pregnancy and antepartum or postpartum depression, were collected. A single pathologist evaluated surgical specimens to note lactational changes while blinded to patient's treatment. The primary endpoint was successful breastfeeding without reporting any lack of or decreased breast milk production. RESULTS: When comparing women who underwent chemotherapy during pregnancy to women who did not, there was a significant difference in reporting a lack of or a perceived decrease in breast milk supply and the need to provide supplemental feeding to their infants (63.5% and 9%, respectively, p < 0.001). In the women who received chemotherapy, there was no significant difference in maternal age, cancer type, or stage with regard to breastfeeding difficulties. Gestational age at the first cycle and the number of cycles were significant factors associated with breastfeeding difficulties (p = 0.006 and p = 0.0003, respectively). Antepartum and postpartum depression was not associated with decreased breast milk production. A lack of lactational changes and significant lobular atrophy were noted in the women given neoadjuvant chemotherapy. CONCLUSION: Women who undergo chemotherapy during a pregnancy are more likely to report breastfeeding difficulties.

Breastfeeding support and early cessation.

OBJECTIVE: To examine the types of help women received with breastfeeding both in the hospital and at home and the reasons why women stopped breastfeeding earlier than intended. DESIGN: A descriptive design with open-ended questions. SETTING: After participant recruitment in the postpartum hospital room, data were collected by phone 8 weeks after delivery. PATIENTS/PARTICIPANTS: Three hundred seventy-nine women planning to breastfeed for at least 8 weeks after uncomplicated delivery. MAIN OUTCOME MEASURES: Breastfeeding status at 8 weeks postpartum; report of help with breastfeeding in the hospital and at home. RESULTS: Sixty-eight percent of women were still breastfeeding at 8 weeks, although 37% of those reported supplementing with formula. Of those who had stopped, the most common reason was insufficient milk supply. Other reasons included painful nipples and latch problems, personal reasons, returning to work or school, and drugs/illness of the mother or baby. Most women received help with breastfeeding in the hospital, but only 55% received help with breastfeeding after hospital discharge. CONCLUSIONS: The primary reasons for early cessation of breastfeeding are amenable to nursing intervention. Every opportunity should be taken to address these issues both in the hospital and through follow-up calls.

Women's experience of lactational mastitis--I have never felt worse.

BACKGROUND: Mastitis is a common problem for breastfeeding women in the postpartum period. METHODS: Ninety-four breastfeeding women participating in a case control study of mastitis provided a free text comment about their experience of mastitis. Women were recruited from the emergency department, wards or breastfeeding clinics of the Mercy Hospital for Women and the Royal Women's Hospital, Melbourne, in 2002-2004. RESULTS: The main themes which emerged from the free text comments were: acute physical illness; negative emotions; life disrupted; to continue breastfeeding or not? A minor theme was 'support for mastitis research'. DISCUSSION: Women with mastitis often experience a rapid onset physical illness accompanied by strong negative feelings, which leads some women to consider stopping breastfeeding while others are determined to persevere. General practitioners need to provide emotional support for women with mastitis and acknowledge that breastfeeding may be difficult for new mothers.

Psychological distress and milk volume in lactating mothers.

The purpose of this article is twofold: (a) to compare psychological distress as measured via self-reported perceived stress, sleep, and fatigue levels in lactating mothers of a term infant and mothers of a preterm infant and(b) to determine whether the addition of psychological distress to a previous model predicts milk volume at Postpartum Week 6 by gestation group. The convenience sample of 95 mothers of a preterm infant (31 weeks) and 98 mothers of a term infant completed the Perceived Stress Visual Analogue Scale, Richards-Campbell Sleep Questionnaire, and the Fatigue Visual Analog Scale. Stress, sleep difficulty, and fatigue levels decreased during the 6-week study period for mothers of a term but not for mothers of a preterm infant. Perceived stress, sleep difficulty, and fatigue during the first 6 weeks postpartum were not related to milk volume; thus, the mother's perceived psychological distress had no apparent effect on lactation.

Psychosomatic factors in patients with hyperprolactinemia and/or galactorrhea.

A biographic and clinical investigation of 101 patients with hyperprolactinemia and/or galactorrhea is reported. Fifty-one patients were reared without their fathers and 18 with an alcoholic, violent one. These situations were uncommon in the control population, and the differences were statistically significant. There was a high frequency of complaints of obesity, headaches, frigidity, lightheadedness, and fullness of the abdomen, limbs, or face. There was a significant temporal correlation of external events in the natural history with onset or worsening of the symptoms. It is concluded that exposure during childhood to an environment characterized by an absent or alcoholic, violent father conditions some women to develop hyperprolactinemia and/or galactorrhea later in life as a response to specific environmental changes. These conclusions apply similarly to patients with prolactinoma, idiopathic hyperprolactinemia, and euprolactinemic galactorrhea, suggesting a close relationship among the 3 entities.

Prenatal, intrapartum, and postpartum support of the lactating mother.

Physicians must continue to improve their knowledge regarding lactation. Improved education will allow for alterations in standard practices that may deter breastfeeding. Presently known influences on successful breastfeeding should direct changes in clinic and hospital practices. Continued research into various aspects of care in and out of the hospital must be pursued to improve maternal-infant care and breastfeeding.

Slow weight gain and low milk supply in the breastfeeding dyad.

There are a large number of women who perceive a reduction in milk supply. With appropriate, knowledgeable advice, most are able to continue breastfeeding successfully. If an infant is not gaining weight normally, the mother's milk production must be assumed to be low (usually a secondary phenomenon); meanwhile, consider the possibility of an organic problem in mother or infant. The complex interactional nature of the problem requires attention to history, physical examination, differential diagnosis, and thoughtful problem solving. There are situations that require infant supplementation for optimal growth; when this is the case, supplementation should be provided in a way that best supports continued breastfeeding to the fullest extent possible. Anticipatory guidance, early detection of problems, and prompt intervention are the keys to ensuring copious milk production and normal infant growth.

Falling by the wayside: a phenomenological exploration of perceived breast-milk inadequacy in lactating women.

OBJECTIVE: To provide insight into the lived experience of breast feeding, in primiparous women. The main focus was upon women's perceptions related to the adequacy of their breast milk, for the purpose of exclusively nourishing their babies. DESIGN: A longitudinal, phenomenological study involving in-depth, interactive interviews, conducted at 6, 12 and 18 weeks following the birth of the women's babies. PARTICIPANTS AND SETTING: A convenience sample of ten primiparous women were recruited prior to discharge from a maternity unit, in the north of England, in 1998. FINDINGS: Two groups of participants emerged, three who became increasingly confident and empowered by breast feeding and the remaining seven whose confidence progressively diminished, with six of them expressing concern that their breast milk was inadequate. Four major themes related to the participants' perceptions emerged from the analysis: the quest to quantify and visualise breast milk; anxiety regarding the adequacy of their diet; breast feeding as a challenging journey, with most feeling that they had 'fallen by the wayside' (this related partly to inadequate and conflicting advice given by health professionals); and finally, unmet needs for support, nurturing and replenishment in return for 'giving out'. CONCLUSION: Perceived breast-milk inadequacy is underpinned by a complex and synergistic interaction between socio-cultural influences, feeding management, the baby's behaviour, lactation physiology and the woman's psychological state. IMPLICATIONS: Education of midwives and health visitors is required in relation to the needs of breast-feeding mothers within a Western industrialised society. Strong social policy is vital in the UK, to initiate socio-cultural changes, which would enable women who commence breast feeding to perceive it as an empowering and fulfilling experience and not one of 'falling by the wayside'.

High prepregnant body mass index is associated with poor lactation outcomes among white, rural women independent of psychosocial and demographic correlates.

To determine whether high prepregnant body mass index (BMI) is associated with later onset of lactogenesis II (LGII) and shorter duration of breastfeeding, we questioned 151 women about their demographic and psychosocial characteristics during pregnancy and about the onset of LGII during days 1 to 5 postpartum. Compared to women with earlier (< 72 hours) onset of LGII, those with later onset had a higher BMI (P < .05), a higher proportion of primiparity (P < .01), and a lower infant score on the Mother-Baby Assessment (P < .05). Prepregnant BMI (P < .04) and primiparity (P < .005) were each associated with later onset of LGII, but only primiparity remained significant when both factors were considered simultaneously. These results suggest that, in addition to those who have just delivered their first infant, those with higher prepregnant BMI values also warrant extra support to decrease their risk of early discontinuation of breastfeeding.

Evaluating the association of two breastfeeding assessment tools with breastfeeding problems and breastfeeding satisfaction.

This pilot study evaluated how the scores from each of two breastfeeding assessment tools correlated with breastfeeding satisfaction and problems. A convenience sample of 30 first-time breastfeeding mothers participated. Mothers were randomly assigned to use either the LATCH or Infant Breastfeeding Assessment Tool (IBFAT). The Maternal Breastfeeding Evaluation Scale (MBFES) and Potential Early Breastfeeding Problem Tool (PEBPT) were used to evaluate the association of the scores of each assessment tool with breastfeeding satisfaction and breastfeeding problems. As scores on the both the LATCH and IBFAT increased, maternal satisfaction scores tended to increase, but not significantly, and breastfeeding problem scores tended to decrease (r = -0.5, p = 0.06 and r = -0.49, p = 0.06; respectively.