Midwifery factors associated with successful breastfeeding

National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Child Care Health and Development (Impact Factor: 1.69). 12/2010; 37(5):744-53. DOI: 10.1111/j.1365-2214.2010.01177.x
Source: PubMed


It is well recognized that breast milk is the best form of nutrition for babies. However, many women do not breastfeed or give up soon after birth. Some report feeling unsupported in the post-natal period and many stop breastfeeding earlier than they would have wished. This study aimed to estimate the separate effects of midwifery factors in the overall context of sociodemographic and clinical influences on breastfeeding.
Data from a national survey conducted in England in 2006 were used. Questionnaires were sent to a random sample of 4800 new mothers (63% response rate). Questions relating to infant feeding allowed calculation of rates of initiation of breastfeeding and rates of exclusive and any breastfeeding in the first few days and at 3 months. Univariate analyses were carried out to estimate the associations between sociodemographic, clinical and midwifery factors and breastfeeding. Logistic regression was used to estimate the specific effects of midwifery factors, while adjusting for other significant variables.
The most powerful explanatory factor was antenatal feeding intention. Maternal age, absence of clinical problems in the baby and a short post-natal stay were important in the early days. At 3 months, breastfeeding was associated with sociodemographic and intrapartum factors. At all stages, breastfeeding was significantly associated with either receiving consistent advice, practical help and/or active support and encouragement from midwives.
The antenatal decision about infant feeding is the most powerful predictor of infant feeding behaviour. Some sociodemographic and clinical factors are also important influences on breastfeeding. However, after adjusting for these, midwifery factors are still influential.

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    • "Sexual & Reproductive Healthcare j o u r n a l h o m e p a g e : w w w. s r h c j o u r n a l . o r g than support focusing on generalised instructions [18], and longterm interventions using various methods have been shown to be more effective than interventions that focus only on the technical aspect of breastfeeding [19]. Despite the continued search for a more complete understanding of first time mothers' breastfeeding experiences and why mothers decide to stop or continue in spite of initial problems, there is a need to disseminate additional personal stories to inform practice and improve knowledge [20]. "
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    ABSTRACT: Objective Despite efforts to improve continued breastfeeding, the percentages of exclusively breastfeeding remain low. To help the breastfeeding mother and reshape professional practice, we need more knowledge of maternal experiences of breastfeeding in the first months. The objective was to explore mothers' early breastfeeding experiences. Method Qualitative content analysis was used to analyse data from 108 Danish first time mothers who had answered an open-ended question 6 months after birth. Results All the mothers started breastfeeding. We identified three overlapping phases presented as dominant themes: (1) on shaky ground, characterised by breastfeeding interwoven with mothering, painful breastfeeding, and conflicting advice, (2) searching for a foothold, characterised by reading the baby's cues, concerns about milk production, for or against breastfeeding, and looking for professional support, and (3) at ease with choice of feeding, characterised by a thriving baby, trust in breastfeeding capability, and approval of feeding preference. Together these themes and subthemes constituted the overall theme: being on a breastfeeding–bonding trajectory. Conclusion Supporting the new breastfeeding mother should include facilitation of the transition to motherhood, learning to read the baby's cues, developing a sense of the right attachment at the breast, and building up the mother's confidence in her capability to care for the baby and produce a sufficient milk supply.
    Full-text · Article · Aug 2014 · Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives
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    • "A number of studies conducted in the UK and other high-income settings have investigated the association between a range of factors and breastfeeding duration. These studies have identified a strong association between duration and antenatal feeding intention and attitudes, [2-5] and socio-demographic factors including ethnicity, [1,4,6,7] age, [1,2,4,8] maternal education [4,8-10] and socio-economic or area deprivation status [1,7,9,11,12]. In addition, factors relating to maternity care and hospital infant feeding practices are associated with breastfeeding continuation, [2,4,9] though an association with labour and birth factors is less clear [2,6,8,13]. "
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    ABSTRACT: Although the majority of women in England initiate breastfeeding, approximately one third cease breastfeeding by six weeks and many of these women report they would like to have breastfed for longer. Data from a survey of women >=16 years who gave birth to singleton term infants in 2009 in England; questionnaires were completed approximately three months postnatally. Logistic regression was used to investigate the association between postnatal support and other factors, and breastfeeding cessation at 10 days and six weeks. Population attributable fractions (PAFs) were calculated to estimate the relative contribution of breastfeeding support factors to overall breastfeeding cessation at these two time points. Of the 3840 women who initiated breastfeeding and reported timing of breastfeeding cessation, 13% had stopped by 10 days; and of the 3354 women who were breastfeeding at 10 days, 17% had stopped by six weeks. Socio-demographic factors (maternal age, ethnicity, country of birth, deprivation, education) and antenatal feeding intention were all independently associated with breastfeeding cessation at 10 days and six weeks. Women who did not receive feeding advice or support from a parent or peer support group, voluntary organisation, or breastfeeding clinic were more likely to stop breastfeeding by 10 days. Perceived active support and encouragement from midwives was associated with a lower odds of breastfeeding cessation at both 10 days and six weeks. Estimated PAFs suggest that 34-59% of breastfeeding cessations by 10 days could be avoided if more women in the study population received breastfeeding support. Although multiple factors influence a mother's likelihood of continuing breastfeeding, it is clear that socio-demographic factors are strongly associated with breastfeeding continuation. However, there is evidence that breastfeeding support, including that delivered by peer or lay support workers, may have an important role in preventing cessations in the first few weeks.
    Full-text · Article · Feb 2014 · BMC Pregnancy and Childbirth

  • No preview · Article · Apr 2011 · Journal of Reproductive and Infant Psychology
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