Journal of Human Lactation recent issues

Your Practice, Your Journal

Heinig, M. J. — 2008-08-08

Essential Leadership Skills, Part III: Fostering Change Through Collaboration

Mannel, R. — 2008-08-08

Letters to the Editor

Powers, D., Heinig, M. J., Panchula, J. — 2008-08-08

Effects of Instituting the "BEST Program" (Breast Milk Early Saves Trouble) in a Level III NICU

2008-08-08

A program is developed to increase the use of breast milk during the first week, for patients < 2 kg birth weight. This is termed the "BEST program," using the acronym "Breast milk Early Saves Trouble." An analysis of feeding practices and outcomes during the 12 months before versus the 12 months after implementing this program was conducted. Demographic features of the patients in the 2 periods were similar. In the "Before Intervention" period, 33% received human milk exclusively in the first 7 feeding days; 50% in the "Intervention" period (P = .009). In the Before Intervention period, 74% received some breast milk; 82% in the Intervention group (P = .046). Banked human milk increased from 2% to 33% of patients (P ≥ .001), and a trend was seen in more mothers who initially wanted to bottle-feed but subsequently changed to breastfeeding (P = .08). A trend was also seen in more infants discharged home breastfeeding (P = .09). J Hum Lact. 24(3):248-251.

Application of the Baby Friendly Hospital Initiative to Neonatal Care: Suggestions by Swedish Mothers of Very Preterm Infants

Nyqvist, K. H., Kylberg, E. — 2008-08-08

The aim of this study was to obtain suggestions from mothers of very preterm infants regarding modification of the Baby Friendly Hospital Initiative (BFHI) 10 Steps to Successful Breastfeeding. Thirteen mothers were interviewed 2 to 6 months after their infants' discharge from the hospital. The interviews generated 13 steps, which partly agree with the BFHI steps. The new steps address respect for mothers' individual decisions about breastfeeding, education of staff in specific knowledge and skills, antenatal information about lactation in the event of preterm birth, skin-to-skin (kangaroo mother) care, breast milk expression, early introduction of breastfeeding, facilitation of mothers' 24-hour presence in the hospital, preference for mother's own milk, semi-demand feeding before transition to demand breastfeeding, special benefits of pacifier sucking, alternative strategies for reduction of supplementation, use of bottle-feeding when indicated, a family-centered and supportive physical environment, support of the father's presence, and early transfer of infants' care to parents. J Hum Lact. 24(3):252-262.

Subclinical Mastitis Is Common Among Ghanaian Women Lactating 3 to 4 Months Postpartum

Aryeetey, R. N. O., Marquis, G. S., Timms, L., Lartey, A., Brakohiapa, L. — 2008-08-08

Subclinical mastitis (SCM) is an asymptomatic inflammation of mammary tissue and has been associated with lactation failure, suboptimal growth in early infancy, and increased risk of mother-to-child transmission of HIV via breast milk. A rapid survey was carried out to determine the prevalence of SCM among lactating Ghanaian women between 3 and 4 months postpartum. Bilateral breast milk samples were obtained from 117 lactating women in Manya Krobo, Ghana and analyzed for sodium (Na) and potassium (K). An elevated sodium/potassium ratio (Na/K) above 1.0 was considered indicative of SCM. Overall, SCM prevalence was observed among 45.3% of the women. About 30% of the women had unilateral SCM. Na/K was associated with maternal age. The high SCM prevalence in Manya Krobo suggests the need for lactation support to reduce SCM and the risk of poor infant outcomes. J Hum Lact. 24(3):263-267.

The Influence of Adolescent Mothers' Breastfeeding Confidence and Attitudes on Breastfeeding Initiation and Duration

Mossman, M., Heaman, M., Dennis, C.-L., Morris, M. — 2008-08-08

A prospective correlational study was conducted to examine the influence of adolescent mothers' breastfeeding attitudes and confidence on breastfeeding initiation and duration. A convenience sample of 100 pregnant adolescents who were contemplating breastfeeding completed the Breastfeeding Self-Efficacy Scale—Short Form (BSES-SF) and the Breastfeeding Attitude Questionnaire (BAQ). The BSES-SF was readministered during the first week postpartum to those adolescents who initiated breastfeeding (n = 84). Adolescents who were breastfeeding at the initial contact received a follow-up contact at 4 weeks postpartum. Comparisons were made between those adolescent mothers who initiated breastfeeding (n = 84) and those who did not (n = 16). Significantly more mothers with higher prenatal attitude scores initiated breastfeeding. Mothers with higher prenatal breastfeeding attitude scores and higher prenatal and postnatal confidence scores were more likely to continue breastfeeding to 4 weeks postpartum. Health professionals are encouraged to develop strategies to enhance breastfeeding attitudes and confidence among adolescent mothers. J Hum Lact. 24(3):268-277.

Are US Mothers Meeting the Healthy People 2010 Breastfeeding Targets for Initiation, Duration, and Exclusivity? The 2003 and 2004 National Immunization Surveys

Forste, R., Hoffmann, J. P. — 2008-08-08

Using data from the National Immunization Surveys (2003 and 2004), the authors model the influence of child, maternal, and state- or metropolitan-level factors on the initiation, duration, and exclusivity of breastfeeding to determine the characteristics of groups meeting the Healthy People 2010 targets. Analyses indicate that only children of college graduates meet the targets for breastfeeding at initiation, 6 months, and 12 months; no groups meet the target for exclusive breastfeeding. Results indicate a low prevalence of breastfeeding among children of single mothers, less educated mothers, participants in the Women, Children, and Infants program, and those living in nonwestern states and in areas of high newborn risk. Hispanic children, children of college graduates, and children living in the West consistently have higher odds of breastfeeding. Only the prevalence of breastfeeding early postpartum is near the Healthy People 2010 target of 75%, the percentages for 6 or 12 months and exclusive breastfeeding are well below. J Hum Lact. 24(3):278-288.

Prevalence Ratio of HTLV-1 in Nursing Mothers From the State of Paraiba, Northeastern Brazil

2008-08-08

The human T-cell lymphotropic virus type 1 (HTLV-1) was the first human retrovirus known as a direct causal agent of a malignant disease. The vertical route of HTLV transmission is the most frequent pathway of the virus contamination. This study was performed to determine the prevalence ratio of HTLV-1 infection among nursing women. From January 2004 to January 2005, blood samples from 1033 nursing mothers from Paraíba, Brazil were evaluated for HTLV antibodies by ELISA and HTLV-1 viral particles confirmed by polymerase chain reaction (PCR). HTLV antibodies were detected in 7 women. The overall seroprevalence ratio was 0.68% and HTLV-1 viral sequences were confirmed by PCR in 2 women. These preliminary data suggest that HTLV screening should be introduced as a mandatory test before breastfeeding and breast milk donation in Paraíba, Brazil. Additionally, counseling programs would help reduce the prevalence ratio of HTLV-1 infected individuals in this Brazilian region. J Hum Lact. 24(3):289-292.

Cesarean Delivery as a Barrier for Breastfeeding Initiation: The Puerto Rican Experience

Perez-Rios, N., Ramos-Valencia, G., Ortiz, A. P. — 2008-08-08

The study's objective was to examine the relationship between cesarean section delivery and the initiation of breastfeeding in a representative sample of 1695 Puerto Rican women aged 15 to 49 years, who delivered their last healthy singleton child in Puerto Rico between 1990 and 1996. Secondary analysis of data collected in the population-based cross-sectional study Puerto Rico Reproductive Health Survey was performed. Bivariate and multivariate logistic regression analyses were used to examine the crude and covariate adjusted association between type of childbirth and initiation of breastfeeding. Overall, 36% of all births were performed by cesarean section, while initiation of breastfeeding was achieved by 61.5% of the women. Cesarean section was negatively related to breastfeeding initiation in multivariable logistic regression models (odds ratio = .64; 95% CI = 0.51-0.81) after controlling for confounding variables. Intervention programs that aim to promote breastfeeding and that provide special assistance to women undergoing this procedure should be developed.

Infant Feeding Intentions and Practices of HIV-Positive Mothers in Southwestern Nigeria

Adejuyigbe, E., Orji, E., Onayade, A., Makinde, N., Anyabolu, H. — 2008-08-08

It has been shown that infant feeding pattern affects mother-to-child transmission of HIV. This study reports the infant feeding practices of HIV-positive mothers in southwestern Nigeria. J Hum Lact. 24(3):303-310.

The Bacteriocin Nisin, an Effective Agent for the Treatment of Staphylococcal Mastitis During Lactation

Fernandez, L., Delgado, S., Herrero, H., Maldonado, A., Rodriguez, J. M. — 2008-08-08

Eight women with clinical signs of staphylococcal mastitis were randomly divided in 2 groups. A solution of the bacteriocin nisin (6 µg/mL) was applied to the nipple and mammary areola of those assigned to the nisin group for 2 weeks, and a similar preparation devoid of nisin was applied to the control group. On day 0, staphylococcal counts in breast milk of the nisin and control groups were similar (5.04 ± 0.19 and 4.88 ± 0.21 log₁₀ CFU/mL, respectively). However, on day 14, the mean in the nisin group (3.22 ± 0.43 log₁₀ CFU/mL) was statistically lower than that of the control group (5.01 ± 0.21 log₁₀ CFU/mL). No clinical signs of mastitis were observed among the women of the nisin group on day 14, whereas they persisted throughout the study in the women of the control group. In conclusion, nisin seems to be an efficient alternative to antibiotics for the treatment of staphylococcal mastitis. J Hum Lact. 24(3):311-316.

An Analysis of Infant Feeding Content Found Within the Hong Kong Print Media

Dodgson, J. E., Tarrant, M., Thompson, J. T., Young, B. — 2008-08-08

Worldwide public media greatly affect women's decisions about infant feeding and may not reflect evidence-based practices. The aims of this research were to (1) describe the characteristics of printed articles having infant-feeding content, (2) describe this thematic content, and (3) compare the thematic content found in groupings based on media type and language (English and Chinese). Four Chinese-language newspapers, the English-language newspaper, and 3 bilingual parenting magazines were analyzed. A multiphase qualitative and quantitative content analysis found 5 themes (social context, mothers' information, effects on baby, the value of breast milk, and the utility of formula). Significant differences were found based on media type and language. Although breastfeeding was usually positively framed in all the media, Chinese media had more inaccurate information. Through this analysis, areas where actions could be taken to improve the quality of information about infant feeding received by the public have been identified. J Hum Lact. 24(3):317-325.

Case Report of Methicillin-Resistant Staphylococcus aureus (MRSA) Mastitis With Abscess Formation in a Breastfeeding Woman

Wilson-Clay, B. — 2008-08-08

An afebrile woman with persistent nonhealing nipples and low-grade intermittent breast pain was diagnosed at 9 weeks postpartum with a methicillin-resistant Staphylococcus aureus infection of the left breast with abscess formation. Unilateral weaning allowed partial lactation to continue. J Hum Lact. 24(3):326-329.

Independent Study Module for Lactation Consultants

2008-08-08

The Breastfeeding Mother and the Pediatrician

Geraghty, S. R., Riddle, S. W., Shaikh, U. — 2008-08-08

An estimated 70% of mothers in the United States initiate breastfeeding annually. Mothers often discuss breastfeeding problems with their infant's pediatrician. Pediatricians may feel unsure about their role when assisting the nonpatient, breastfeeding mother. By having practical solutions and support systems in place to anticipate and tend to breastfeeding mothers' needs, pediatricians can be instrumental in preventing early weaning. The purpose of this article is to provide practical suggestions to outpatient-based pediatric health care providers when assisting the breastfeeding dyad. J Hum Lact. 24(2):335-339.

Breastfeeding after Weight Loss Surgery

Kombol, P. — 2008-08-08

Association News

Brooks, L. — 2008-08-08

JHL Notes

2008-08-08

Recent References

2008-08-08

Achieving Work/Life Balance as a Lactation Consultant

Heinig, M. J. — 2008-04-24

Essential Leadership Skills, Part II

Mannel, R. — 2008-04-24

Synthesizing Breastfeeding Research: A Commentary on the Use of Women's Ways of Knowing

Ordway, M. R. — 2008-04-24

Breastfeeding Rates in Iran: Why Is There Such a Large Gap Between Iran and Other Countries?

Maddah, M. — 2008-04-24

Promotion of WHO Feeding Recommendations: A Model Evaluating the Effects on HIV-Free Survival in African Children

David, S., Abbas-Chorfa, F., Vanhems, P., Vallin, B., Iwaz, J., Ecochard, R. — 2008-04-24

In Africa, HIV and feeding practices deeply affect child mortality. To prevent mother-to-child transmission, the World Health Organization recommends exclusive breastfeeding for 6 months and replacement feeding when acceptable, feasible, affordable, and sustainable. Determining the proportion and number of children saved with exclusive breastfeeding and replacement feeding is essential to design and implement crucial nationwide policies. Using data on 31 sub-Saharan countries and a decision tree for risk assessment, the authors estimated the number of children's lives potentially saved according to 6 scenarios that combine exclusive breastfeeding for 6 months or replacement feeding with 3 promotion strategies. Among all HIV-negative children born to HIV-positive mothers who die in sub-Saharan Africa per year, 52 315 (9.6%) would be saved yearly with exclusive breastfeeding versus 21 638 (4.0%) with replacement feeding. Promotion support would double these numbers (110 625 vs 45 330; ie, 20.3% vs 8.3%), and with additional prenatal group education, 132 633 versus 54 192 lives would be saved (24.3% vs 9.9%). Wherever replacement feeding is not possible, exclusive breastfeeding with promotion support and prenatal group education would save 1 of 4 exposed children. J Hum Lact . 24(2):140-149.

The Association Between an Electric Pump Loan Program and the Timing of Requests for Formula by Working Mothers in WIC

Meehan, K., Harrison, G. G., Afifi, A. A., Nickel, N., Jenks, E., Ramirez, A. — 2008-04-24

An electric pump loan program designed to facilitate breastfeeding for low-income mothers returning to full-time work was evaluated. All mothers were WIC participants in the Los Angeles area. Electric pump loans were made until the infant's first birthday or until the mother requested formula from WIC. Information was provided to employers on supporting breastfeeding in the workplace. A subsample of mothers who received an electric pump on return to full-time work was compared with counterparts in a wait list control group. Mothers who received an electric pump as soon as requested did not request formula until 8.8 months on average, whereas those who did not receive an electric pump requested formula on average at 4.8 months (P < .0001). Mothers who received an electric pump when requested were 5.5 (95% CI 2.0-15.1) times as likely as mothers who did not receive an electric pump to not request formula at 6 months. J Hum Lact. 24(2):150-158.

Nutrient Composition of Hindmilk Produced by Mothers of Very Low Birth Weight Infants Born at Less Than 28 Weeks' Gestation

Bishara, R., Dunn, M. S., Merko, S. E., Darling, P. — 2008-04-24

The objectives of this study were to describe and compare retinol, -tocopherol and -tocopherol, fat, energy, and nitrogen concentrations between the foremilk and hindmilk fractions of 24-hour milk collected by 24 mothers of very preterm (< 28 weeks' gestation) infants and to relate milk vitamins A and E content to maternal vitamin intake. Concentrations of retinol were significantly higher in hindmilk than in foremilk (1.6-fold), as were concentrations of -tocopherol (1.6-fold), -tocopherol (1.5-fold), fat (1.7-fold), energy (1.3-fold), and nitrogen (1.05-fold). Retinol, -tocopherol, and -tocopherol were positively related (P < .05) to milk fat and energy but not to maternal intake. Estimates of vitamins A and E intakes of infants fed hindmilk with added human milk fortifier surpassed current recommended upper level of intakes. The higher fat-soluble vitamin content of hindmilk produced by mothers of very low birth weight infants needs to be considered in the design and recommendations for use of human milk fortifier. J Hum Lact . 24(2):159-167.

Early Interruption of Exclusive Breastfeeding and Associated Factors, State of Sao Paulo, Brazil

2008-04-24

Many reports about breastfeeding prevalence and factors associated with weaning have been published in the scientific literature. However, the influence of newborn feeding practices on the duration of exclusive breastfeeding has received less attention. This study provides information about the introduction of liquids, other than the mother's milk, to infants in the first 6 months and factors associated with this practice. J Hum Lact. 24(2):168-174.

Race, Education, and Breastfeeding Initiation in Louisiana, 2000-2004

Chin, A. C., Myers, L., Magnus, J. H. — 2008-04-24

Although it is well documented that race and education are associated with breastfeeding initiation, the possible interaction between these 2 demographic variables has not been explored in a geographically stable, biracial population. This study explores the relationship between race, education, and breastfeeding among women in Louisiana. J Hum Lact. 24(2):175-185.

Attitudes, Knowledge, and Intentions Related to Breastfeeding Among University Undergraduate Women and Men

Marrone, S., Vogeltanz-Holm, N., Holm, J. — 2008-04-24

The purpose of the current study was to examine university undergraduate women's and men's attitudes and knowledge toward breastfeeding. Data were gathered for 111 women and 50 men. Data showed a significant relationship between positive attitudes toward breastfeeding and exposure to breastfeeding. Women and participants older than 20 years scored higher on measures of knowledge and attitudes. Results indicated that positive attitude toward breastfeeding was a significant predictor of intention to breastfeed among women and men. In conclusion, the results suggest that understanding attitudes among young adults is an important line of research. Further studies are needed to develop and evaluate interventions aimed at improving attitudes about breastfeeding and increasing initiation of breastfeeding among this population. J Hum Lact. 24(2):186-192.

Breastfeeding Promotion: A Rational and Achievable Target for a Type 2 Diabetes Prevention Intervention in Native American Communities

Murphy, S., Wilson, C. — 2008-04-24

Type 2 diabetes is a serious, costly, and increasingly common disease among Native American communities. Increasing evidence suggests that early infant nutrition, particularly breastfeeding, may have a significant impact on the development of diabetes in later life. In this report, the authors describe the scientific basis and development of an innovative program that targets promotion of breastfeeding among Native women as a type 2 diabetes prevention intervention. The program materials, evaluation methods, and outcomes are presented. By developing and sharing strategies that effectively support breastfeeding, the impact of diabetes in Native American communities will be reduced. J Hum Lact. 24(2):193-198.

Belly Models as Teaching Tools: What Is Their Utility?

Spangler, A. K., Randenberg, A. L., Brenner, M. G., Howett, M. — 2008-04-24

Marble/ball models are often used to represent newborn stomach capacity; however, their accuracy has not been determined. The objective of this review was to analyze data on newborn stomach capacity and determine whether marble/ball models serve as accurate representations. A literature search yielded limited data, most emanating from the early 1900s. Data suggest that anatomic capacity of the newborn stomach varies with the birth weight of the infant. Physiologic capacity bears no relation to anatomic capacity of the newborn stomach but is a measure of the ability of the mother to produce milk and the newborn to ingest milk. Given the wide range of feeding volumes on days 1 and 3 and the reported 8-fold increase in average feeding volume during the same time period, it is best to acknowledge that feeding volumes like anatomic stomach capacity vary widely and do not lend well to visual representation by marble/ball models. J Hum Lact. 24(2):199-205.

Is Breastfeeding Fair? Tensions in Feminist Perspectives on Breastfeeding and the Family

McCarter-Spaulding, D. — 2008-04-24

Breastfeeding is widely acknowledged to have health benefits for mothers and infants. Because it is sex-specific, it challenges the feminist principle of gender-neutral childbearing. Various feminist theories addressing breastfeeding from the perspective of gender ideology, cultural feminism, and history are reviewed and contrasted. Employment and race disparities are addressed within feminist contexts. Feminist health activism is suggested as a unifying perspective. J Hum Lact. 24(2):206-212.

Independent Study Module for Lactation Consultants

2008-04-24

A Case of Well-Established Breastfeeding for a 61-Year-Old Woman After Menopause

Emmersen, P. B., Kronborg, V. H., Illeborg, L., Mathiesen, E. R. — 2008-04-24

During recent years, an increasing number of women who have become pregnant after fertility treatment, including oocyte transplantation, have presented at obstetric departments. A number of these women want to breastfeed their children even though they are postmenopausal. However, whether this is possible has remained doubtful, and any possible special needs in establishing their breastfeeding are not described. The experience of establishing breastfeeding in a postmenopausal woman aged 61 years is reported. J Hum Lact. 24(2):217-218.

ILCA's Inside Track: Take Care of Your Breastfed Baby's Teeth

Peterson, A., Chandler, S. — 2008-04-24

Association News

Brooks, L. — 2008-04-24

JHL Notes

2008-04-24

Recent References

2008-04-24

Essential Leadership Skills, Part I

Mannel, R. — 2008-02-01

An American IBCLC's Observations on Breastfeeding in Iran

Good Mojab, C. — 2008-02-01

Breastfeeding and Infant Illness in Low-Income, Minority Women: A Prospective Cohort Study of the Dose-Response Relationship

Freeman, K., Bonuck, K. A., Trombley, M. — 2008-02-01

The authors' objective was to determine whether cumulative weekly breastfeeding duration by 13 weeks was associated with infant otitis media, respiratory and gastrointestinal illness, and total illness visits up to 12 months. The authors performed a secondary analysis of data from a randomized clinical trial of low-income, primarily Hispanic and Black women enrolled from 2 medical center affiliated clinics. "Breastfeeding sensitive" (BFS) outpatient and emergency room (ER) visit data for the above illnesses were obtained for 255 mother/infant dyads. Outcome measures were unadjusted and adjusted rates of outpatient and ER visits with sick and BFS diagnoses. The authors found no significant associations between breastfeeding intensity and infant visits for otitis media, respiratory and gastrointestinal illness, or total illness visits. In this low-income, multiethnic sample, breastfeeding intensity was not associated with infant health service use, in contrast to other evidence-based reports. Low exclusive breastfeeding rates and lack of coverage for health visits may be reasons for this finding. J Hum Lact. 24(1):14-22.

Independent Study Module for Lactation Consultants

2008-02-01

Newborn Wet and Soiled Diaper Counts and Timing of Onset of Lactation as Indicators of Breastfeeding Inadequacy

Nommsen-Rivers, L. A., Heinig, M. J., Cohen, R. J., Dewey, K. G. — 2008-02-01

Using data from 242 exclusively breastfeeding mother-infant pairs, newborn elimination patterns were analyzed. Sensitivity (Se) and Specificity (Sp) of day 4 (72-96 hours) wet and soiled output, in addition to the timing of onset of lactation, in identifying cases of breastfeeding inadequacy (defined as neonatal weight loss ≥ 10% of birth weight) were examined. The usefulness of 2 measures in parallel was also explored. Median number of diapers (wet, soiled) on days 1, 4, and 7, respectively, was 2, 3; 5, 4; and 7, 6. The most efficient day 4 predictor of breastfeeding inadequacy was soiled diaper output ≤ 3 (Se = .75, Sp = .66). Sensitivity improved when used in parallel with delayed onset of lactation (≥ 72 hours); Se = .86 (95% confidence interval, .73-.99) and Sp = .59 (.55-.63). Fewer than 4 soiled diapers on day 4 when used in conjunction with delayed onset of lactation may be indicative of breastfeeding inadequacy, but low specificity will result in many false positives. J Hum Lact. 24(1):27-33.

The Impact of Maternal HIV Status on Infant Feeding Patterns in Nakuru, Kenya

Kamau-Mbuthia, E., Elmadfa, I., Mwonya, R. — 2008-02-01

The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P < .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (> mean birth weight, P < .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital. J Hum Lact . 24(1):34-41.

Ethnic Variation in Infant-Feeding Practices in the Netherlands and Weight Gain at 4 Months

2008-02-01

This prospective study of 4438 infants (0-4 months) examined differences in infant-feeding patterns in relation to the ethnic origin of their mothers, based on the mother's native language: Dutch (87%), Turkish (4%), Moroccan (3%), other European languages (3%), and various other languages (4%). Breastfeeding at birth varied between 75% and 94%. Dutch and Moroccan mothers breastfed for a shorter period (32% and 37% at 4 months, respectively) than did Turkish mothers and mothers with a native European language other than Dutch (47% and 51% at 4 months, respectively; P < .001). Of all mothers, 71% started exclusive breastfeeding at birth, and 21% continued exclusive breastfeeding for at least 4 months. The reasons why mothers discontinued breastfeeding (both exclusive breastfeeding and breastfeeding) were generally infant related. The average weight gain between birth and day 133 was 3.45, 3.87, and 3.69 kg for Dutch, Turkish, and Moroccan infants, respectively. Weight gain was influenced by ethnicity of the mothers and exclusive breastfeeding. J Hum Lact. 24(1):42-49.

Risk for Postpartum Depression, Breastfeeding Practices, and Mammary Gland Permeability

2008-02-01

In a cross-sectional study, 163 breastfeeding women completed the Edinburgh Postnatal Depression Scale (EPDS), a questionnaire on demographics and infant feeding and hand-expressed breast milk for Na and K quantification, between 2 and 12 weeks postpartum. Forty women (24.5%) had an EPDS score compatible with the risk of a depressive episode, and 63 (41%) did not feel confident about breastfeeding. These 2 variables were significantly correlated to each other and individually correlated to breastfeeding exclusiveness. Weeks postpartum was correlated to breastfeeding exclusiveness and Na:K in milk (all P < .001). A logistic regression model showed that supplementation increased the risk of high Na:K in milk by 209%, whereas a longer time postpartum lowered the risk for mammary gland permeability. This study suggests that postpartum depression and low breastfeeding confidence, which may be present concomitantly, are associated with increased mammary gland permeability, only to the extent in which depression dissuades the mother from exclusive breastfeeding. J Hum Lact. 24(1):50-57.

Electronic Health Records in an Outpatient Breastfeeding Medicine Clinic

2008-02-01

The Institute of Medicine has issued a call for the implementation of computer-based patient records. The purpose of this overview is to describe the content developed for an electronic health record in an outpatient breastfeeding medicine clinic at a pediatric health care facility. Additional features of the computer system, including electronic prescriptions, printed patient handouts, and follow-up telephone notes, utilized in this setting are also described. As more hospital systems and outpatient offices adopt electronic medical record systems, the authors recommend that lactation personnel work with administrators and computer professionals at their institution to incorporate the special needs of an outpatient lactation clinic into their system. J Hum Lact. 24(1):58-68.

The Human Milk Donation Experience: Motives, Influencing Factors, and Regular Donation

2008-02-01

The aim of this investigation was to identify factors that influenced or motivated women (N = 737) to donate human milk to human milk banks in Alagoas, Brazil. The most common characteristics of a regular donor were having 4 to 7 pregnancies (relative risk [RR] = 1.9285; 95% confidence interval [CI] = 1.0388-3.5800) and having obtained a higher education level (RR = 2,0625; 95% CI = 1.0097-4.2130). The most commonly reported reasons for donating were "encouragement of a health professional" (61.3%), followed by "the needs of the babies the banks serve" (25.3%). Most of the donors (49.9%) were introduced during their stay in the hospital to the human milk bank to which they donated, and 25.8% chose the bank recommended by a health professional. Health professionals play an indispensable role in motivating mothers to become human milk donors. J Hum Lact. 24(1):69-76.

Case Study Revisiting the Association Between Breastfeeding and Postpartum Depression

Sharma, V., Corpse, C. S. — 2008-02-01

Recent studies have focused on the impact of postpartum depression on breastfeeding; however, the role of breastfeeding and weaning in the onset of postpartum depression has not been adequately studied. This article describes the case of a woman who had 3 episodes of major depression, each following closely the cessation of breastfeeding. The clinical and research implications of the association between weaning and the onset of postnatal depression are discussed. J Hum Lact. 24(1):77-79.

Exploration of Guilt Among Mothers Who Do Not Breastfeed: The Physician's Role

Labbok, M. — 2008-02-01

Physicians commonly state the concern that, if they promote breastfeeding, they may "impose guilt upon those who do not breastfeed." This article explores the genesis of this fear, who may benefit from this construct, and the terminology of guilt, shame, and loss. The article also explores the responsibility for both lactation failure and associated shame, considering the roles and responsibilities of physicians, the media, and society as a whole. An alternative construct for the guilt is offered, based on the consideration that the woman experiences lack of breastfeeding as a loss at some level, conscious or subconscious, and whether the choice to not breastfeed is her decision or imposed. Proposed approaches for acting to prevent and to treat shame and guilt are presented. J Hum Lact. 24(1):80-84.

ILCA's Inside Track: Breastfeeding and Returning to Work...Working Out the Details

Page, D. — 2008-02-01

Association News

2008-02-01

JHL Notes

2008-02-01

Research to Practice: An Informal Quiz for Lactation Professionals

2008-02-01

Short-Term Effects of Smoking on Breastfed Infants

Chapman, D. J. — 2008-02-01

ILCA Abstracts

2008-02-01

Conquering Anxiety in Lactation Consultant Practice

Heinig, M. J. — 2007-11-08

Letter to the Editor

Heads, J. — 2007-11-08

Breastfeeding Attitudes and Reported Problems in a National Sample of WIC Participants

McCann, M. F., Baydar, N., Williams, R. L. — 2007-11-08

Recent reports indicate that breastfeeding rates continue to be dramatically lower among WIC participants, compared with other US mothers. The WIC Infant Feeding Practices Study was a nationally representative 1-year longitudinal study of WIC participants that obtained information about attitudes regarding infant feeding and about infant-feeding practices. Hispanic mothers were most likely to agree with statements about benefits of breastfeeding, and Black mothers were most likely to agree with statements about barriers. Concern about insufficient milk was common in all ethnic groups. Perceived benefits were associated with breastfeeding initiation (P < .05), longer breastfeeding duration (P < .01), and later formula initiation (P < .01); for barriers, the opposite pattern was found. Breastfeeding mothers who reported concern about insufficient milk breastfed for shorter durations (P < .001) and initiated formula earlier (P < .01). These results suggest possible messages that should be communicated as part of a re-energized WIC breastfeeding promotion campaign. In particular, maternal anxiety about insufficient breast milk must be addressed. J Hum Lact. 23(4):314-324.

Infant Feeding Practices in the First 6 Months and Associated Factors in a Rural and Semiurban Community in Mangochi District, Malawi

Kamudoni, P., Maleta, K., Shi, Z., Holmboe-Ottesen, G. — 2007-11-08

This cross-sectional study aimed at investigating infant feeding practices and their sociodemographic correlates in Mangochi District, Malawi. Questionnaire data from 157 rural and 192 semiurban mother-infant pairs were obtained. Early breastfeeding (< 1 hour after delivery) was practiced among 68.2% of the rural and 63% of the semiurban mothers. Colostrum was given by 96% of the sampled mothers. Exclusive breastfeeding rates in the sample at 2, 4, and 6 months were 39.1%, 27.5%, and 7.5%, respectively. At 4 months, exclusive breastfeeding was significantly higher in the semiurban (46.8%) than in the rural (4.7%) group. Living in the rural area (OR = 1.87; 95% CI 1.26-2.76) and giving birth outside a health facility (OR = 1.36; 95% CI 1.00-1.85) were risk factors for stopping exclusive breastfeeding before 6 months. The results suggest that semiurban mothers are more likely to practice optimum breastfeeding and that health facilities have an important role in its promotion. J Hum Lact. 23(4):325-332.

Comparison of Milk Output Between Breasts in Pump-Dependent Mothers

Hill, P. D., Aldag, J. C., Zinaman, M., Chatterton, R. T. — 2007-11-08

This article reports the naturally occurring pattern of milk output beginning day 6 through day 42 postpartum from each individual breast in 95 pump-dependent mothers of a non-nursing preterm infant. Of the 3488 study days, milk output was greater from the left breast on 51.6% (n = 1800) of the study days, from the right breast 45.8% (n = 1598) of the study days, and equal 2.6% (n = 90) of the study days. Overall, total left and right breast milk output for the entire study (37 days) was 52.6% and 47.4%, respectively. There was no significant relationship between individual breast milk output and maternal handedness, parity, or breastfeeding experience. Clinicians need to assess the total milk output as well as individual breast output in lactating mothers, as there may be significant disparities in milk production. J Hum Lact. 23(4):333-337.

Identifying Predictors of the Reasons Women Give for Choosing to Breastfeed

Brodribb, W., Fallon, A. B., Hegney, D., O'Brien, M. — 2007-11-08

The aims of this article are to outline the reasons Australian women give for initiating breastfeeding, identify unique predictors for these reasons, and use principal components factor analysis to determine factors that influence a woman's decision to breastfeed. Data were collected as part of a large longitudinal study investigating the breastfeeding behaviors and supports of women in Southern Queensland, Australia. The most common reason women (N = 562) gave for deciding to breastfeed was breast milk is better for my baby (95.5%). Reasons related to the mother such as breastfeeding is more convenient (84.3%) were also popular. Four significant components—mother-related reasons, health effects for the infant, moral and family influences, and advice from others—were determined after principal components factor analysis. As well as health benefits for the infant, convenience and other reasons related to the mother appear to be important factors in an Australian woman's decision to breastfeed. J Hum Lact. 23(4):338-344.

Breastfeeding Information in Nursing Textbooks Needs Improvement

Philipp, B. L., McMahon, M. J., Davies, S., Santos, T., Jean-Marie, S. — 2007-11-08

The objective of this study was to determine if breastfeeding information in maternal-child (nursing) textbooks used in the United States is accurate and up to date. Six nursing textbooks, all published since 1999, were reviewed using a standardized scoring sheet. Five reviewers (1 pediatrician, 2 lactation consultants, 1 nurse, and 1 research assistant) examined breastfeeding content in each text. Each textbook was graded for inclusion of 20 basic breastfeeding facts derived from recommendations from the American Academy of Pediatrics and the World Health Organization. Of the 20 criteria scored, the mean number present was 17 (range, 14-19). For each category, the mean number of criteria was correct (11.8; range, 10-15) incorrect (5.2; range, 2-8), and omitted (3.0; range, 1-6). The scores were Pilliteri 10/20 (50%), Ladewig 11/20 (55%), Leifer 11/20 (55%), Ball 12/20 (60%), London 12/20 (60%), and Klossner 15/20 (75%). Thus, breastfeeding information in these nursing textbooks, when not omitted, was at times found to be inaccurate and inconsistent. J Hum Lact. 23(4):345-349.

Characterization of Human Milk Donors

Osbaldiston, R., Mingle, L. A. — 2007-11-08

The primary objective of this research was to create a detailed characterization of human milk donors, including descriptive information about demographics and lifestyle, involvement with the milk bank, reasons for donating, problems encountered while breastfeeding and pumping milk, barriers to donating milk, affective experiences, and personal values. Data were collected via telephone interview of 87 donors and 19 nondonor controls. Few relationships were found between the descriptive information and amount of milk donated. Donors reported fewer problems pumping milk than nondonors. Strategies for recruiting new donors and strategies for increasing donation amounts are presented. J Hum Lact. 23(4):350-357.

Independent Study Module for Lactation Consultants

2007-11-08

Optimizing Breastfeeding Promotion and Support in Adolescent Mothers

Feldman-Winter, L., Shaikh, U. — 2007-11-08

The United States has the highest teen birth rate in the industrialized world, and adolescents continue to have the lowest rates of breastfeeding. Although individual pregnancy and parenting experiences in adolescents are modified by a variety of factors, common themes of adolescent psychology and behavior may help plan effective strategies for breastfeeding promotion and support. Breastfeeding promotion and support in adolescents need to be developmentally appropriate, patient centered, and linked to multidimensional support. J Hum Lact. 23(4):362-367.

ILCA's Inside Track: Breastfeeding Your Baby Who Arrived Slightly Early

Barger, J. — 2007-11-08

Association News

Brooks, L. — 2007-11-08

JHL Notes

2007-11-08

The Burden of Proof: A Commentary on "Is Breast Really Best: Risk and Total Motherhood in the National Breastfeeding Awareness Campaign"

Heinig, M. J. — 2007-11-08

Recent References

2007-11-08