The effect of a single irradiation of low-level laser on nipple pain in breastfeeding women: a randomized controlled trial.

Photobiomodulation with low-level laser therapy (PBM-LLLT) has been introduced as a new tool to relieve nipple pain and repair nipple damage in breastfeeding women; however, evidence is needed to assess its effectiveness. The aim was to evaluate the effect of a single application of PBM-LLLT for breastfeeding women with nipple pain and damage; side effects were also collected. We conducted a randomized double-blinded controlled trial with women with nipple damage who were exclusively breastfeeding and rooming-in at Amparo Maternal maternity service, São Paulo, Brazil (May 2016 to May 2017). Women were randomly assigned into laser (n = 40) or control group (n = 40). Intervention was a single irradiation (660 nm, 100 mW, 2 J, 66.66 J/cm2, 3.3 W/cm2, 20 s of irradiation, punctual, and continuous mode) applied directly. Women reported pain levels at recruitment (before and immediately after irradiation), 6 and 24 h after the treatment. Pain level during a breastfeed was assessed using the Visual Analogue Scale (0 to 10). The primary outcome was the level of nipple pain immediately after the laser irradiation. Data were analyzed using hierarchical model and Wald test. At baseline, pain levels were similar (mean of 7.4 in laser group and 7.1 in control group). Women's perception of pain reduced approximately one point in both groups. Thirty-one percent of participants in the laser group (11/36) reported secondary effects, such as tingling (10/36) and pricking (2/36). The laser protocol of a single application was not effective in reducing pain in women with damaged nipples. Tingling sensation may be experienced by women receiving laser treatment for nipple damage.

Trends in clinical management of lactational mastitis among women attending Australian general practice: a national longitudinal study using MedicineInsight, 2011-2022.

OBJECTIVE: To examine longitudinal trends in clinical management of lactational mastitis in women attending general practice. DESIGN: Open cohort study. SETTING: Australian general practice using data from MedicineInsight. PARTICIPANTS: Women aged 18 to 44 years with one or more clinical encounters for lactational mastitis between January 2011 and July 2022. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the proportion of prescribed oral antibiotics based on the antibiotic type. Secondary outcome measures were the proportion of women prescribed other medications (eg, antifungals, lactation suppressants) or ordered selected clinical investigations including breast ultrasound, blood test, breast milk culture, nipple swab culture or breast aspirate. Outcomes were examined based on the calendar year and individual- or clinical practice-level characteristics. RESULTS: Among 25 002 women who had one or more clinical encounters related to mastitis, 90.9% were prescribed oral antibiotics. While the proportion of women prescribed an oral antibiotic remained consistent from 2011 to 2022 (91.1% vs 92.5%), there were changes in the proportion receiving prescriptions for di/flucloxacillin (46.1% vs 60.4%) and cefalexin (38.6% vs 26.5%). Fewer than 12% of women were clinically investigated for their mastitis encounter, most commonly a breast ultrasound (7.1%), followed by a selected blood test (3.8%). Requests for breast milk cultures, nipple swab cultures or breast aspirates occurred in less than 1.1% of individuals. Significant increases were evident with respect to ordering of all clinical investigations, with rates at least doubling between 2011 and 2022 (6.6% vs 14.7%). Large variability in clinical management was evident according to both individual- (eg, concessional status) and clinical practice-level characteristics (eg, remoteness). CONCLUSIONS: Australian general practitioners commonly prescribe oral antibiotics to women with mastitis and largely in line with clinical guidelines. Their use of clinical investigations as part of mastitis management has increased over the last decade.

Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study.

OBJECTIVES: Using routinely collected hospital data, this study explored secular trends over time in breast feeding initiation in a large Australian sample. The association between obesity and not breast feeding was investigated utilising a generalised estimating equations logistic regression that adjusted for sociodemographics, antenatal, intrapartum and postpartum conditions, mode of delivery and infant's-related covariates. DESIGN: Population-based retrospective panel. SETTING: A regional hospital that serves 26% of Victoria's 6.5 million population in Australia. PARTICIPANTS: All women experiencing live births between 2010 and 2017 were included. Women with missing body mass index (BMI) were excluded. RESULTS: A total of 7491 women contributed to 10 234 live births. At baseline, 57.2% of the women were overweight or obese, with obesity increasing over 8 years by 12.8%, p=0.001. Although, breast feeding increased over time, observed in all socioeconomic status (SES) and BMI categories, the lowest proportions were consistently found among the obese and morbidly obese (78.9% vs 87.1% in non-obese mothers, p<0.001). In the multivariable analysis, risk of not breast feeding was associated with higher BMI, teenage motherhood, smoking, belonging to the lowest SES class, gravidity >4 and undergoing an assisted vaginal or caesarean delivery. Compared with women with a normal weight, the obese and morbidly obese were 66% (OR 1.66, 95% CI 1.40 to 1.96, p<0.001) to 2.6 times (OR 2.61, 95% CI 2.07 to 3.29, p<0.001) less likely to breast feed, respectively. The detected dose-response effect between higher BMI and lower breast feeding was not explained by any of the study covariates. CONCLUSION: This study provides evidence of increasing breast feeding proportions in regional Victoria over the past decade. However, these proportions were lowest among the obese and morbidly obese and those coming from the most disadvantaged backgrounds suggesting the need for targeted interventions to support breast feeding among these groups. The psychosocial and physiological associations between obesity and breast feeding should further be investigated.

Breastfeeding--managing 'supply' difficulties.

BACKGROUND: Many breastfeeding women have concerns about their milk supply; 'not enough milk' is the most common reason women give for stopping breastfeeding, however their concern is often unwarranted. OBJECTIVE: The article describes the process of history taking and examination of mother and infant to determine if the mother's milk supply is adequate, the causes of insufficient milk supply, and possible investigations and management. DISCUSSION: Insufficient milk supply may be secondary to maternal conditions such as postpartum haemorrhage or breast reduction surgery, or infant factors such as tongue-tie or ill health. In many cases, milk supply can be increased by frequent, regular milk removal. Medication to increase milk supply (galactogogues) such as domperidone, may also play a role. General practitioners can provide reassurance if milk supply is adequate, or can assist in resolving the problem if milk supply is low.

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.

Breastfeeding and the introduction of solids in Australian infants: data from the 2001 National Health Survey.

OBJECTIVE: To present estimates on rates of breastfeeding and timing of introduction of solid foods to Australian children, 1998-2001. METHODS: Analysis of data from the 2001 Australian National Health Survey (NHS) using lifetable methods. Infant feeding questions were asked by personal interview in respect to 1,883 children aged under three years of age. RESULTS: At discharge from hospital, 83.3% of infants were breastfeeding, which is similar to estimates from the 1995 NHS. At 13 weeks postpartum, 64.3% were breastfeeding, 49.0% at 25 weeks and 24.9% were continuing to breastfeed at one year. At 25 weeks, 18.4% of infants were fully breastfed. Solid food was being offered regularly to 15.2% of infants at 13 weeks and 88.0% by 26 weeks. CONCLUSION: Fewer than 50% of infants are receiving breast milk at six months, which is considerably lower than the 80% figure recommended by the latest Dietary Guidelines for Children and Adolescents. Very few Australian infants are being exclusively breastfed for the recommended six months. Infant feeding practices in Australia appear to have remained unchanged between 1995 and 2001.

Why do women stop breastfeeding? A closer look at 'not enough milk' among Israeli women in the Negev Region.

The aim of this study was to describe the breastfeeding experience of a sample of Israeli women. A random telephone survey of women, aged between 25 and 42, who had children under the age of 18 and were resident in the Negev Region of Israel (N=302) was conducted. Women had an average of three children each (range 1-11) and most breasted for less than three months. The most common reason given for not breastfeeding or breastfeeding less than three months was 'not enough milk' (90/205; 44%). A four-factor solution was extracted from a factor analysis of the reasons that women gave for stopping breastfeeding before three months or for not initiating breastfeeding. The four factors were: personal concerns (body image, tired, return to work); need help (wants husband to help, child unwell, didn't like breastfeeding), uncomfortable (nipple/breast pain, didn't like breastfeeding) and not confident (not enough milk). Women most frequently report that they stopped breastfeeding because they have insufficient milk, yet the lack of any consistent sociodemographic correlation indicates that this may be a universal way of expressing lack of confidence in breastfeeding.

A failed RCT to determine if antibiotics prevent mastitis: Cracked nipples colonized with Staphylococcus aureus: A randomized treatment trial [ISRCTN65289389].

BACKGROUND: A small, non-blinded, RCT (randomised controlled trial) had reported that oral antibiotics reduced the incidence of mastitis in lactating women with Staphylococcus aureus (S. aureus)- colonized cracked nipples. We aimed to replicate the study with a more rigorous design and adequate sample size. METHODS: Our intention was to conduct a double-blind placebo-controlled trial to determine if an antibiotic (flucloxacillin) could prevent mastitis in lactating women with S. aureus-colonized cracked nipples. We planned to recruit two groups of 133 women with S. aureus-colonized cracked nipples. RESULTS: We spent over twelve months submitting applications to five hospital ethics committees and seven funding bodies, before commencing the trial. Recruitment to the trial was very slow and only ten women were randomized to the trial after twelve months, and therefore the trial was stopped early. CONCLUSIONS: In retrospect we should have conducted a feasibility study, which would have revealed the low number of women in these Melbourne hospitals (maternity wards and breastfeeding clinics) with damaged nipples. The appropriate use of antibiotics for breastfeeding women with cracked nipples still needs to be tested.

The introduction of breast milk substitutes and solid foods: evidence from the 1995 National Health Survey.

OBJECTIVE: To report the introduction of breast milk substitutes and solid foods to Australian children between 1992 and 1995. METHODOLOGY: Analysis of data from the 1995 Australian National Health Survey. Infant feeding questions were asked by personal interview in respect to 3,252 children aged under four years of age. RESULTS: By the age of 26 weeks, the majority of children had been given infant formula (56.9%) and solid food (61.5%). More than one-quarter (27.1%) of children received cow's milk regularly during the first 12 months. Only 7% of children were given solids in the first 12 weeks of life. Soy milk was given to 14.2% of children aged less than four years. CONCLUSION: The majority of children in Australia are not being exclusively breastfed for six months as recommended by the World Health Organization (WHO). The intake of cow's milk before 12 months of age and the timing of introduction of solids needs to be monitored. Future surveys should collect more detail about type of infant formula so that the proportion of infants receiving soy-based formula and other formula can be assessed.

Breast pain in lactating women--mastitis or something else?

BACKGROUND: Mastitis is a common problem for lactating women. However, medical practitioners may not recognise that there are also other causes of breast pain during lactation. OBJECTIVE: This article presents a case study that demonstrates several common causes of breast and nipple pain in a lactating woman. DISCUSSION: Once medical practitioners are aware of the presenting features of mastitis, candida infection and vasospasm, they will be able to conduct a careful history and examination and make the correct diagnosis.

Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence.

Women who smoke are less likely to breastfeed their children than nonsmokers. It is thought that nicotine has a negative effect on breastmilk supply by suppressing prolactin levels. The aim of this review was to assess the epidemiological evidence that maternal smoking has a negative physiological effect on breastfeeding. The following data sources were searched: The Cochrane Library, Medline, CINAHL, Current Contents, Psychinfo, Sociological Abstracts and the Lactation Resource Centre (Australian Breastfeeding Association) using the key words 'smoking' and 'breastfeeding' or 'infant feeding'. The Journal of Human Lactation and Birth were hand searched. Women who smoke are less likely to intend to breastfeed, less likely to initiate breastfeeding, and likely to breastfeed for a shorter duration than nonsmokers. Several studies have found a dose-response relationship between the number of cigarettes smoked each day and breastfeeding intention, initiation, and duration that persists after adjusting for confounding factors. In some population groups a high proportion of smokers breastfeed successfully. The association between maternal smoking and lack of breastfeeding is consistent across different study designs in a range of countries. Given that women who smoke are less likely to intend to breastfeed, however, it cannot be assumed that the relationship between smoking and duration of breastfeeding is a physiological one. If smoking had a consistent negative physiological effect on lactation, one would not expect to see such wide variations in breastfeeding rates among women who smoke. Therefore, it is likely that psychosocial factors are largely responsible for the lower rates of breastfeeding found in women who smoke compared with those who do not.

Review of tongue-tie release at a tertiary maternity hospital.

OBJECTIVE: To review the first 12 months of assessment and release of lingual frenulum (frenotomy) at a breast-feeding clinic in a tertiary maternity hospital (August 2002 to end of July 2003) and to report on the breast-feeding outcomes and parental satisfaction. METHODS: A structured telephone interview was conducted with the mother at least 3 months after the assessment. Data were collected about the presenting problem and the effect of release of the tongue-tie (if performed). Parents were also asked about their satisfaction with the procedure and of problems following the release. RESULTS: Sixty-six babies were assessed in 12 months. If infants were assessed as: (i) having impaired lingual function (using the Hazelbaker assessment tool for lingual frenulum function); (ii) the frenulum visualized to be a thin membrane; and (iii) the parent(s) gave informed consent, the frenulum was released. Initial and follow-up data are available on 46 infants. Infants had a mean age of 18 days (range 3-98), 63% were male infants and most had difficulties with attachment to the breast. Frenotomy was performed on 35 infants and breast-feeding improved in 83%. Parents reported high levels of satisfaction with the frenotomy procedure and no complications were reported. CONCLUSION: Frenotomy is a safe and easy procedure. Infants with a significant tongue-tie that is interfering with breast-feeding have shown an improvement with breast-feeding following frenotomy.

Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence.

BACKGROUND: Women who smoke are less likely to breastfeed their children than nonsmokers. It is thought that nicotine has a negative effect on breastmilk supply by suppressing prolactin levels. The aim of this review was to assess the epidemiological evidence that maternal smoking has a negative physiological effect on breastfeeding. METHODS: The following data sources were searched: The Cochrane Library, Medline, CINAHL, Current Contents, Psychinfo, Sociological Abstracts and the Lactation Resource Centre (Australian Breastfeeding Association) using the key words "smoking" and "breastfeeding" or "infant feeding." The Journal of Human Lactation and Birth were hand searched. RESULTS: Women who smoke are less likely to intend to breastfeed, less likely to initiate breastfeeding, and likely to breastfeed for a shorter duration than nonsmokers. Several studies have found a dose-response relationship between the number of cigarettes smoked each day and breastfeeding intention, initiation, and duration that persists after adjusting for confounding factors. In some population groups a high proportion of smokers breastfeed successfully. CONCLUSIONS: The association between maternal smoking and lack of breastfeeding is consistent across different study designs in a range of countries. Given that women who smoke are less likely to intend to breastfeed, however, it cannot be assumed that the relationship between smoking and duration of breastfeeding is a physiological one. If smoking had a consistent negative physiological effect on lactation, one would not expect to see such wide variations in breastfeeding rates among women who smoke. Therefore, it is likely that psychosocial factors are largely responsible for the lower rates of breastfeeding found in women who smoke compared with those who do not.