No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Principles for Maintaining or Increasing Breast Milk Production
Abstract
Breastfeeding rates in many developed countries remain low, and maternal perception of insufficient milk production is a major contributing factor. Mothers with a perception of insufficient milk should be advised that normal breastfeeding frequencies, suckling times, and amounts are very variable. If objective assessment confirms insufficient milk production, mothers should ensure optimal milk removal frequency and thorough breast drainage. In addition, galactogogues can be prescribed. Understanding physiological principles underlying milk production will help clinicians reassure and assist mothers.
... Suckling also acts to stimulate the sensory nerves in the nipple, which send impulses to the hypothalamus to stimulate the release of oxytocin [6,8]. Oxytocin plays an important role in the milk ejection reflex [9]. However, other stimuli that cause oxytocin release include the sight or sound of the infant [10], suggesting a possible psychologic component in the milk ejection reflex [6]. ...
... However, other stimuli that cause oxytocin release include the sight or sound of the infant [10], suggesting a possible psychologic component in the milk ejection reflex [6]. The first four days of the postpartum period are marked by colostrum production, with mature milk being produced after fifteen days [11]; removal of milk by postpartum day three is important in establishing the lactation feedback loop [9]. Lactating patients are advised to breastfeed eight to twelve times per day to maintain adequate milk production and can use one or both breasts [9]. ...
... The first four days of the postpartum period are marked by colostrum production, with mature milk being produced after fifteen days [11]; removal of milk by postpartum day three is important in establishing the lactation feedback loop [9]. Lactating patients are advised to breastfeed eight to twelve times per day to maintain adequate milk production and can use one or both breasts [9]. Infants will request feeding based on their appetite, and breastfeeding should be initiated on infant demand [3]. ...
PurposeThe purpose of this article is to summarize available data on breastfeeding in patients with a cancer diagnosis.Materials and MethodsA review of available literature in the MEDLINE database was performed and the data summarized. In addition, two patient interviews were conducted to gain insight into the patient perspective.ResultsBreastmilk is the nutritional standard for human infants and understanding the implications of a cancer diagnosis on lactation is important in optimizing maternal and infant outcomes. Though limited, available data suggest that breastfeeding may be a safe and appropriate option for some patients undergoing treatment of a malignancy.Conclusions
Patient experiences with breastfeeding in the setting of a cancer diagnosis vary widely, and depend on the type of malignancy, the timing of the diagnosis, and the indicated treatment. Breastfeeding may be an appropriate option for certain patients after multidisciplinary counseling. Alternatives to breastfeeding exist for patients who are unable to or do not desire to breastfeed.
... Inadequate milk production is one of the main reasons mothers give Page 2 of 9 Piccolo et al. International Breastfeeding Journal (2022) 17:14 for weaning or using alternative methods like formula feed [1][2][3]. Human milk insufficiency (HMI) can lead to hypoglycemia, hypernatremia, nutritional deficiencies, and failure to thrive in newborns and infants [4]. HMI is not clearly defined in the literature, but it can be measured by volumetric milk outputs, infant weight gain, glucose levels, stool and urine output, muscle tone, and alertness [2]. ...
... Human milk insufficiency (HMI) can lead to hypoglycemia, hypernatremia, nutritional deficiencies, and failure to thrive in newborns and infants [4]. HMI is not clearly defined in the literature, but it can be measured by volumetric milk outputs, infant weight gain, glucose levels, stool and urine output, muscle tone, and alertness [2]. Perceived insufficient milk (PIM) supply is well-defined in the literature as the state in which a mother perceives that she has an inadequate supply of milk to meet an infant's needs [5]. ...
... Existing literature on HMI highlights maternal and infant physiological factors that can lead to the insufficient production of mother's milk. Kent and colleagues highlight infant functional reasons for insufficient milk supply, including medical conditions like preterm birth, hypothyroidism, congenital heart disease, cleft palate, and neurological disturbances [2]. Maternal factors that may lead to HMI include inadequate mammary tissue, disturbed ductal and neurological pathways, and abnormal concentrations of hormones including oestrogen, prolactin, progesterone, oxytocin, growth hormone, glucocorticoids, and insulin [21]. ...
Background
Human milk insufficiency is a significant barrier to implementing breastfeeding, and it is identified as a prevalent concern in 60–90% of mothers in low-and-middle-income countries. Breastmilk insufficiency can lead to hypoglycemia, hypernatremia, nutritional deficiencies, and failure to thrive in newborns and infants. Studies investigating the impact of breastfeeding interventions to improve milk production highlight inconsistencies between healthcare workers and mothers perceived support, as well as gaps in practical knowledge and training. The aim of this study was to determine perceptions surrounding human milk insufficiency from Malawian healthcare workers.
Methods
This study is a secondary analysis of 39 interviews with healthcare workers from one tertiary and three district hospitals in Malawi employing content analysis. Interviewed healthcare workers included nurses, clinical officers, midwives, and medical doctors. An inclusive coding framework was developed to identify themes related to human milk insufficiency, which were analyzed using an iterative process with NVivo12 software. Researchers focused on themes emerging from perceptions and reasons given by healthcare workers for human milk insufficiency.
Results
Inability to produce adequate breastmilk was identified as a prevalent obstacle mothers face in the early postpartum period in both district and tertiary facilities in Malawi. The main reasons given by participants for human milk insufficiency were mothers’ perceived normalcy of milk insufficiency, maternal stress, maternal malnutrition, and traditional beliefs around food and eating. Three focused solutions were offered by participants to improve mother’s milk production – improving education for mothers and training for healthcare providers on interventions to improve mother’s milk production, increasing breastfeeding frequency, and ensuring adequate maternal nutrition pre- and post-partum.
Conclusion
Health care workers perspectives shed light on the complexity of causes and solutions for human milk insufficiency in Malawi. This research highlights that a respectful professional relationship between health care workers and mothers is an essential bridge to improving communication, detecting human milk insufficiency early, and implementing appropriate interventions. The results of this study may help to inform research, clinical practice, and education in Malawi to improve human milk production.
... The longer the breastfeeding duration, the more it will ensure each breast is empty, thus increasing the supply of milk volume. 31 Nevertheless, the nature of breast milk production is quite adaptive to baby. Research reveals that breast adaptability to baby suction compare to no other. ...
... 35 This study emphasizes that emptying the breast when expressing milk or direct feeding will keep the baby's milk required. 31 Although the sociodemographic barriers addressed in this study are not statistically related to milk production, working mothers, early initiation, frequency and length of breastfeeding are findings that preserved the milk production pathway through external mechanisms. ...
Objective: Breast milk (ASI) is a nutrient that is produced from cellular secretion and transportation
activities in the breast organs. The development cycle of the organ of ASI secretion begins to form from
the neonate, puberty to pregnancy 1. Until now, several assumptions that state that the production of
breastfeeding of a nursing mother are influenced by various external and internal factors. External factors
involve the environment, sociodemography, and even sociocultural2.
Method: The volume of milk assessed on days 7th, 8th, 9th, postpartum. Milk volume measured through
pumping using a Medela Swing Double Pump electric breast pump for 15 minutes, the weighted milk is
then returned for drinking to the baby using new media (spoon or cup feeding). Sociodemographic variables,
obstetric history, and lactation history were measured using an observation form, postpartum is then grouped
into two groups; breastfeeding mothers with optimal and sub-optimal milk production. The relationship
between variables was tested by the chi-square test and logistic regression test.
Results: Occupational variables (p <0.049; OR = 2.61), initiation of early breastfeeding (p <0.022; OR =
2.73), frequency of breastfeeding (p <0.003; OR = 4.62), duration of breastfeeding (p <0.018; OR = 2.76)
demonstrates relationship with milk volume.
Conclusion: This research succeeded in proving several external factors such frequent and timing that
supported the mechanical mechanism of breast milk production.
... Penelitian sebelumnya oleh Kent, ibu setelah melahirkan yang menunda waktu menyusui akan memberikan efek negatif durasi menyusui dan produksi ASI (Kent et al., 2012). Hari pertama kehidupan bayi baru lahir adalah masa-masa kritis untuk proses laktasi, sehingga perlu adanya dukungan yang kuat bagi ibu untuk mencegah kegagalan proses menyusui (WHO, 2017). . ...
... Ibu dengan umur lebih muda akan memproduksi ASI lebih banyak daripada ibu dengan umur lebih tua. Selain itu pendidikan ibu dapat mempengaruhi kemampuan dan upaya dalam melakukan perawatan dan memelihara kesehatan anak serta beradaptasi terhadap peran sebagai orang tua sehingga dapat lebih mudah mencapai sesuatu (Kent et al., 2012). Ibu nifas sebagian besar multipara, produksi ASI pada ibu multipara cenderung lebih banyak dibandingkan dengan primipara pada hari keempat postpartum. ...
Approximately 38-63% of primiparous postpartum mothers experience lactation insufficiency, which has an impact on not breastfeeding their babies. The purpose of this study was to determine the characteristics and factors associated with postpartum mothers' milk production at the Public Health Center of Semarang City. This type of research is observational and cross-sectional design. The population of all postpartum women in Semarang City in October 2021, was taken by cluster random sampling at 8 selected health centers and a sample of 124 postpartum women. Methods of collecting data were questionnaires and data analysis with chi-square. The results of the research are the characteristics of mothers with an average age of 28 years, 56.5% of secondary education, 40% of primiparous parity, 59% of normal BMI, 92.7% of normal LILA, average age of the baby was 7 days, 82.3% of moderate anxiety level, 99.2% off good staff support, 58.9% of good surveillance worker support, 91.1% of good family support, 82.3% of more calorie intake of 2200 kcal, 62.1% of 1600 ml more fluid intake. There was a relationship between anxiety, family support, health volunteer support, calorie and fluid intake with breast milk production (p-value <0.05). There was no relationship between the support of health workers with postpartum mothers' milk production (p = 0.166). Mother’s psychological condition while breastfeeding, support from family, and health insurance are important things in increasing breast milk production as a continuation of breastfeeding and exclusive breastfeeding. In addition, calorie and fluid intake need to be considered to maintain the adequacy of mother's milk.
... 35 36 Using expressed HM to address early lactation concerns may result in disruption to the establishment of a full milk supply, which relies on frequent suckling and effective milk removal by the infant. 37 Use of a high quality breast pump which mimics infant suckling may assist in this process, but this requires frequent pumping sessions with full drainage of the breasts. 37 We also found that, in addition to expressed HM use, in-hospital formula supplementation and not having access to IBCLC services through the CPNP predicted early cessation of HM feeding in our cohort. ...
... 37 Use of a high quality breast pump which mimics infant suckling may assist in this process, but this requires frequent pumping sessions with full drainage of the breasts. 37 We also found that, in addition to expressed HM use, in-hospital formula supplementation and not having access to IBCLC services through the CPNP predicted early cessation of HM feeding in our cohort. ...
Objectives:
To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months.
Design:
Pooled data from two prospective cohort studies SETTING: Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada.
Participants:
337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum.
Exclusions:
pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum.
Primary and secondary outcome measures:
Main exposure variable: any use of expressed human milk at 2 weeks postpartum.
Outcomes:
cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum.
Results:
All participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84).
Trial registration numbers:
NCT03400605, NCT03589963.
... Because it is hard to calculate exclusively breastfed infants' daily human milk consumption precisely, we used human milk intake average constant value. Commonly maternal milk production of an exclusively breastfeeding woman is between 1-and 6-months' averages 750 to 800 mL/day (20). Thus, we assumed that infants daily ingest approximately 800 mL of human milk (21). ...
... We selected healthy mothers who have 1-3 months exclusively breastfed a healthy infant. Exclusively breastfed infants' approximately average breast milk utilization is 750-800 mL/day (20). To the best of our knowledge, BPA is excreted into human milk (28) and naturally transferred to the infant via breastfeeding (5). ...
Objective:
Bisphenol A exposure is crucial for lactating women and exclusively breastfed infants. Bisphenol A transfers directly by breastfeeding and may cause adverse health outcomes. We conduct this study to determine maternal human milk bisphenol A level and exclusively breastfed infants' bisphenol A exposure. We investigated the effect of exposure according to participants' nutritional habits.
Methods:
We enrolled voluntarily, healthy postnatal, exclusively breastfeeding women (n=80) and collected hindmilk samples. Human milk-free bisphenol A concentration was analyzed using a competitive ELISA method. Free (unconjugated) BPA has been detected in human samples indicating that humans are internally exposed to estrogenically active BPA. Participants' demographic properties, nutritional habits were questioned with an elaborated survey face-to-face by the researcher.
Results:
Human milk median free bisphenol A level is 0.63 µg/L. There was no statistically significant association between maternal body mass index, birth type, parity, infant birth week, infant birth weight, and human milk bisphenol A concentration. Nevertheless, we only found a statistically significant association between human milk bisphenol A level and fast-food, carbonated drinks consumption (p=0.022 and p=0.018, respectively). Exclusively breastfed infants' bisphenol A exposure was 0.0099±0.0079 µg/kg bw/day. There was a negative moderate statistically significant correlation between infant bisphenol A exposure and infant current body weight (r= 0.327, p=0.003).
Conclusion:
Exclusively breastfed infants bisphenol A exposure was under the tolerable bisphenol A level (4 µg/kg bw/day), and infants' current dietary exposure level was safe.
... Therefore, a human milk intake average constant value was used. Maternal milk production of an exclusively breastfeeding woman between 1-and 6-months averages to approximately 750 to 800 mL/ day (20). Thus, it was assumed that infants daily ingestion would be approximately 800 mL of human milk (21). ...
... Participants were healthy mothers with 1-3 month-old, exclusively breastfed, healthy infants. Exclusively breastfed infants estimated breast milk consumption was assumed to be 750-800 mL/day (20). BPA is reported to be incorporated into human milk (28) and is subsequently naturally transferred to the infant via breastfeeding (5). ...
Objective:Bisphenol A (BPA) is a known endocrine disruptor and free BPA will interact with estrogen. BPA is also fat soluble and will therefore contaminate breast milk. The European Food Safety Authority has set a limit for temporary tolerable daily intake of 4 μg/kg body weight/day in breastfeeding infants. The aim of this study was to measure human milk BPA concentrations in Turkish women and thus exclusively breastfed infants’ exposure to BPA.Methods:Healthy, postnatal, exclusively breastfeeding women were recruited and breast milk samples were collected. Free BPA concentration was analyzed in the milk samples using competitive enzyme-linked immunosorbent assay. Participants’ demographic characteristics and nutritional habits were investigated through face-to-face interviews using a detailed questionnaire.Results:Eighty women participated. Median milk free BPA level was 0.63 μg/L. There was no statistically significant association between maternal body mass index, birth type, parity, infant birth week, infant birth weight, and human milk BPA concentration. Nevertheless, there was a significant association between human milk BPA level and consumption of fast-food and carbonated drinks (p=0.022 and p=0.018, respectively). Exclusively breastfed infants’ mean BPA exposure was 0.0099±0.0079 μg/kg bw/day. There was a moderate negative significant correlation between infant BPA exposure and infant current body weight (r=0.327, p=0.003).Conclusion:BPA exposure in exclusively breastfed infants was within accepted limits and the current dietary exposure level of infants in this cohort was safe.
... This perception of an insufficient milk supply improved in a small subset of mothers who were surveyed after receiving targeted lactation advice despite lack of confirmation of increased milk production [49]. Three methods are available to measure milk production: deuterium dilution [50,51], test weighing [52] and hourly pumping [53,54], with all methods having advantages and disadvantages. Deuterium dilution does not provide information about breastfeeding patterns and has a long analysis time and requires specialist equipment, precluding its use as a routine clinical tool. ...
... However, test weighing allows investigation of breastfeeding patterns as well as the effectiveness of milk removal by the infant with instantaneous results. The hourly pumping technique offers an alternative in cases where a mother is not able to carry out test weighing but requires the infant to be fed expressed milk [53,55] and still needs more formal validation before it can be considered for routine use [54]. As such, 24 h test weighing has underpinned many of the research studies in our laboratory. ...
Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.
... Around 3-4 days postpartum, milk supply becomes more abundant (Kent et al., 2012;Neville & Morton, 2001). If the stimulation to breasts persists, breast milk will peak in response to infant sucking within a month of delivery; but if mothers add formula supplementation due to PIMS and gradually cease breastfeeding, prolactin will return to pre-pregnant levels and milk production will stop (Dahl, 2015;McGuire, 2018). ...
... A report found that only 5% of mothers experienced actual milk insufficiency due to pathological abnormalities (Neifert, 2001), suggesting that the remaining mothers have the physiological ability to produce enough breastmilk. Some influencing factors were shown to affect the secretion of actual milk production, such as caesarean section, delayed breastfeeding initiation, formula supplementation, and infants' ineffective sucking (Amir, 2006;Geddes, 2007;Hill et al., 2007;Hobbs et al., 2016;Huang et al., 2009;Kent et al., 2012Kent et al., , 2016Neville & Morton, 2001;Newman & Pitman, 2015). If mothers fail to achieve adequate breastfeeding frequency, duration, or necessary degree of breast emptying, especially the first month after delivery, actual milk insufficiency might occur (Dahl, 2015). ...
Perceived insufficient milk supply (PIMS) is one of the major reasons for discontinued breastfeeding. We aimed to estimate the rates and evaluate related factors of PIMS. We searched four databases for relevant articles published from January 2000 to March 2021. We then performed a meta‐analysis of the pooled data to estimate the rates and related factors of PIMS using Stata 15.0. Descriptive analyses of textual data were performed to summarise the related factors of PIMS if data could not be synthesised quantitatively. The quality of included studies was assessed using Newcastle–Ottawa scale (NOS), AHRQ checklist or Consolidated Criteria for Reporting Qualitative Research (COREQ). Overall, 27 studies were included in this review. At different periods after delivery, approximately 50% of mothers reported PIMS as the reason for stopping breastfeeding, while for breastfeeding mothers, the incidence of PIMS ranged from 10% to 25%. Breastfeeding initiation (OR 4.22, 95%CI 1.57–11.34) and breastfeeding knowledge (OR 7.10, 95%CI 2.00–25.26) were two factors influencing PIMS. Besides, PIMS had a strong negative relationship with breastfeeding self‐efficacy (r = −0.57); moderate negative association with infant suck ability (r = −0.46) and planned breastfeeding duration (r = −0.45); and a moderate positive correlation with formula supplementation (r = 0.42). Descriptive analyses revealed that infant crying was reported to be a sign of PIMS, and inadequate intake of energy/liquids was a reported cause of it. This review identified a high proportion of women reporting PIMS, particularly among those who stopped breastfeeding. Deliberate interventions were needed to improve breastfeeding for mothers at risk.
... 2,9 Relaxation technique, direct breastfeeding, skin-toskin contact,body massage, expressing milk with the presence of infant and increasing the frequency of milk expression between 8 to 12 times per day resulted in increment of milk production. 4,11 In this paper, both of the mothers were advised to do skin-to-skin contact with their infants, practice SNS feeding, perfom bilateral breasts massage before expressing their milk with double elctrical pump. Combining breast massage with breast expression increases the amount of milk expressed. ...
... However, the frequency of milk stimulation requires a very high level of commitment, motivation and determination from the mothers. 11 After the mothers were able to achieve regular expression for eight times a day, the domperidone tablet was prescribed. Besides that, both of them have taken natural galactogoues i.e. palm dates and fenugreek as early as two weeks after their first consultation. ...
Induced lactation is a process of producing breast milk in non-puerperal women. There are various reasons for adoptive mothers to breastfeed their adopted child through induced lactation method. For Muslim communities, the main motivating factor for an adoptive mother to breastfeed their adopted child is to establish a mahram relationship. The mahram relationship allows the adopted child to interact with other family members as if they are biologically related. The mahram relationship is achieved when adoptive mothers give breastmilk to the adopted child aged less than two years old for at least five satisfying feedings. In this paper we report the journey of two women who went through the induced lactation process in order to achieve mahram relationship with their adopted infant. In both cases, the mothers were finally able to produce milk, feed their adopted infant and reach mahram relationship. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.918-922
... ; https://doi.org/10.1101/2023.01.24.23284943 doi: medRxiv preprint 19 301 The use of an innovative breastfeeding arm sling helped the mothers who participated 302 in this study to hold the baby's body without any slipping during breastfeeding so that 303 the baby's mouth and head were in a position in alignment with the nipple. Correct 304 positioning and attachment of newborns during breastfeeding was one of the 305 recommendations by Kent et al. [21], to help reduce nipple pain, increase the duration 306 of breastfeeding, and reduce breastfeeding problems. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint ...
Breastfeeding has many benefits for the newborn and mother therefore, the World Health Organization guidelines recommend exclusive breastfeeding for the first 6 months, with continued breastfeeding for up to two years. However, exclusive breastfeeding rates in the first 6 months in Thailand were reported to be approximately, 14% in 2019. Research has highlighted that many mothers’ have a lack of belief in their ability to breastfeed, and some physical conditions, such as tiredness and difficulty continually holding their baby in a comfortable position. Additionally, first-time breastfeeding can contribute to mothers having difficulties breastfeeding during the early postnatal period. Therefore, the Arm sling innovation (device) has been designed to provide support and comfort whilst holding the newborn. This study compared the effectiveness of the breastfeeding arm sling innovation to support breastfeeding in cross-cradle hold position and normal cross-cradle hold position breastfeeding in first-time mothers. A quasi-experimental pretest-posttest research design was used to evaluate the effectiveness of breastfeeding before and after the intervention among first-time mothers in the postnatal unit, at Ramathibodi hospital, Thailand. A total of 46 postpartum mothers participated in the study. The results showed that the effectiveness of breastfeeding reported by mothers between using a normal cross-cradle hold position and using breastfeeding arm sling innovation was statistically significantly different (t = 4.32, P < 0.001) with helping to hold the baby securely without slipping (t=5.68, p<0.001) and mothers can continue to breastfeed (t=2.09, p <0.001). Majority of mothers were satisfied with the support of using the breastfeeding arm sling innovation design. The breastfeeding arm sling innovation contributes to the effectiveness of breastfeeding by assisting and supporting the mother and baby’s position to breastfeed more comfortably, thus assisting first-time mothers to feel comfortable, confident, and able to continue breastfeeding.
... 20 In addition, a nursing infant will instinctively increase the frequency and demand of feeds if the infant experiences a drop in supply in direct nursing sessions. 21,22 When such a feedback mechanism is not present, such as in the event of exclusive pumping, the supply-demand feedback loop is dependent on the frequency and length of pumping sessions. It is generally recommended that milk removal occurs frequently, every 2 to 3 hours, to maintain milk supply. ...
Introduction
Active duty flight crew plays a critical role in military operations. The occupational demands of the flying environment require a certain level of medical suitability. Additionally, such an environment could be more hazardous for certain populations. While the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the World Health Organization strongly support exclusive breastfeeding for the health benefit of both the mother and the child in the first 6 months of life, the aeromedical implications of lactating are not widely discussed. Breastfeeding is inherently challenging for many women, in part because of the frequent emptying required to maintain breastmilk supply and avoid complications such as engorgement, clogged ducts, and mastitis. This pilot study evaluated the experiences of individuals concurrently breastfeeding while on active duty Naval flying status to (1) assess whether these individuals experience frequent challenges or complications associated with lactating and (2) establish the need for future expanded studies.
Materials and Methods
This survey-based, retrospective, descriptive study evaluated the experiences of 17 lactating individuals on active duty Naval flying status. Women were recruited using word of mouth and social media platforms. Responses were tabulated and summarized from the survey, which included yes/no questions and free-response sections regarding flying position, breastfeeding history, and breastfeeding challenges. This trial was approved by the Naval Air Warfare Center Aircraft Division (NAWCAD) Institutional Review Board (Protocol Number NAWCAD.2021.0004-IR-EP7).
Results
Of the 27 women who received study materials after expression of interest, 17 individuals completed the informed consent and survey protocols. Although limited by sample size and the demographics of respondents, the results highlight that the active duty flying environment did impact the breastfeeding experiences of the participants, with 88% of respondents reporting some difficulty or complication associated with breastfeeding and the operational flying environment. Difficulty in maintaining breastmilk supply, engorgement, and the need for supplementation were some of the concerns discussed.
Conclusions
This study hypothesizes that occupational demands associated with aviation result in a decreased ability to maintain exclusive breastfeeding, an increased risk for engorgement and clogged ducts, and a higher likelihood of early weaning among Naval aviators. It included only the perspectives of Naval officers, thereby lacking the input of enlisted aircrew on flight status, who comprise a large population of active duty flyers. The responses, although limited by a lack of controls and survey limitations, indicate that a future study to expand understanding of the aeromedical implications on lactating individuals would be valuable for improving workplace support and the ultimate success of lactating women in meeting their breastfeeding goals.
... Dokter dapat menggunakan informasi ini untuk mendidik dan meyakinkan ibu untuk membangun kepercayaan dirinya ketika produksi ASInya memadai. Pemahaman tentang prinsip fisiologis ini memberikan dasar untuk tindakan yang dapat membantu ibu ketika didiagnosis dengan produksi ASI yang tidak mencukupi (Kent et al., 2012) Bayi yang mendapat ASI mendapat manfaat yang dapat meningkatkan kesehatannya sepanjang hidupnya. Manfaat ASI bagi anak antara lain peningkatan daya tahan tubuh terhadap penyakit infeksi, seperti gastroenteritis, infeksi saluran pernapasan, dan infeksi telinga. ...
Air susu ibu (ASI) merupakan karunia terbesar yang diberikan oleh Tuhan kepada manusia. ASI sendiri merupakan sumber nutrisi terbaik bagi hampir semua bayi. Di luar pertumbuhan somatik, ASI sebagai cairan biologis memiliki berbagai manfaat lain, termasuk modulasi fungsi usus pascakelahiran, peningkatan kekebalan, dan perkembangan otak. Rendahnya capaian angka keberhasilan ibu dalam memberikan ASI ekslusif merupakan masalah yang cukup besar dalam era sekarang. Kesibukan orang tua sebagai pekerja membuat ASI tidak diberikan secara maksimal. Kegiatan pengabdian masyarakat ini diadakan untuk memberikan pengetahuan tentang ASI melalui kelas laktasi online. Kegiatan ini memberikan manfaat kepada seluruh peserta antusiasme peserta dalam kegiatan ini sangat besar, sebagai tindak lanjut dan evaluasi dibuatlah grup WA yang nantinya kan membuat para peserta akan bertanya dan berbagi pengalaman kepada satu sama lain
... Penelitian (Kent et al., 2012) menyatakan bahwa persepsi ibu mengenai ASInya yang tidak mencukupi masih manjadi salah satu factor utama yang berkontribusi, sehingga ibu yang memiliki persepsi ini harus disarankan untuk menyusui dengan frekuensi normal minimal delapan kali sehari, waktu menyusui sesering mungkin tanpa jadwal. Penelitian ini sejalan dengan penelitian (Angriani et al, 2018) yang menyatakan bahwa ibu yang memiliki frekuensi menyusui yang baik memiliki peluang 2,438 kali produksi ASI lebih lancar dari pada ibu yang memiliki frekuensi menyusui kurang baik. ...
Cakupan ASI ekslusif ini masih dibawah target pencapaian 80% baik di Dunia maupun di Indonesia. Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan, frekuensi menyusui, dan hisapan bayi dengan produksi ASI. Metode: Jenis penelitian merupakan analitik observasional dengan menggunakan desain cross sectional. Populasi pada penelitian ini semua ibu- ibu menyusui ASI ekslusif dan PASI di wilayah kerja Puskesmas 23 Ilir Palembang. Jumlah sampel dalam penelitian ini 85 responden, data diambil dengan menyebarkan kuesioner. Teknik pengambilan sampel dengan Purposive Sampling. Teknik analisa data menggunakan uji Chi-Square. Hasil: Hasil uji statistic ada hubungan yang signifikan antara penegtahuan ibu dengan produksi ASI (P=0.012), ada hubungan sginifikan antara frekuensi menyusui dengan produksi ASI (P=0.006), dan terdapat hubungan yang signifikan antara hisapan bayi dengan produksi ASI (P=0.094). Kesimpulan dalam penelitian ini adalah ibu perlu memiliki pengetahuan tentang manfaat ASI, sehingga ibu akan sering menyusui bayinya, semakin sering disusui maka produksi ASI pun semakin banyak. Saran petugas-petugas kesehatan tetap memberikan KIE mengenai ASI ekslusif terutama untuk ibu yang belum ada pengalaman dalam memberikan ASI.
... Higher prolactin levels were also accompanied by an increase in breastmilk volume in both groups. Increased levels of prolactin and lactation are physiological mechanisms of breastfeeding [36], [37], [38]. In a stressful environment, a nursing mother will continue to breastfeed and produce milk without disrupting the lactation cycle by high cortisol levels. ...
BACKGROUND: Research shows postnatal depression and shorter breastfeeding are consistently related, but their causal effect remains debatable. To reduce the impact of mental disorders in the perinatal period, lactation may give a significant neuroendocrine effect. AIM: This study aimed to examine hormonal patterns and estimated breastmilk volume of mothers with depression. MATERIALS AND METHODS: This study was conducted during the three-trimester to 6-week postnatal period. It involved 60 pregnant women from South Sulawesi, Indonesia. Analysis of variance with repeated measures was used to compare and review fluctuations and effect sizes of cortisol, prolactin, and breastmilk volume of mothers with depression symptoms. RESULTS: The mean cortisol levels rose in the 4th week and decreased in the 6th week in both groups. There was no substantial difference in the cortisol levels between these periods (p = 0.534; p = 0.553; and p = 0.660), but the prolactin levels continuously increased by 2 weeks and substantially progressed in the 4th and 6th weeks (p < 0.028, p < 0.009), respectively. There was no positive association between cortisol and prolactin levels (p = 0.384). The breastmilk volume was higher every week only in mothers without depression and it slightly decreased in other categories. This study emphasized the prolactin’s protective effect size on a stressful environment characterized by high cortisol; a significant rise in prolactin levels occurred in the 2nd and 4th weeks of postnatal, marking the higher lactation. CONCLUSIONS: Breastfeeding hormones may provide protection against postpartum depression in moms. It is critical to establish a history of prior trauma in nursing mothers in order to facilitate diagnosis and proper care.
... One recommendation for facilitating effective drainage is to make the mother as physically and psychologically comfortable as possible. In this context, the expected psychological condition is that the mother is not stressed and in a calm condition (38). ...
Background: Indonesia is severely affected by the COVID-19 pandemic, particulary in the
context of exclusive breastfeeding. Breastfeeding is the safest for babies in disaster situations, and the success of breastfeeding is a social and collective responsibility, as well as also a woman’s decision. The focus of this study is to explore the strengthening and weakening elements of breastfeeding experience during the COVID-19 pandemic.
Methods: This is an exploratory qualitative study design, conducted in Yogyakarta Special Region Province, with nine lactating mothers who participated in the study. Interviews were audio-recorded, transcribed, translated and thematically analysed.
Results: Strengthening elements in breastfeeding mothers during the pandemic were
maternal affection to her baby, support system from family and community, and having adaptive coping strategy. The weakening elements were impaired comfort, insufficient milk supply, financial problem, parenting problem and indifferent husband.
Conclusion: Breastfeeding a baby is appropriate even in a pandemic situation. Thus, to
achieve good clinical practices that encourage breastfeeding, the support process should include a subjective and social component, and strengthen the support network of breastfeeding mothers in this COVID-19 pandemic situation. This will help to resolve the barrier in breastfeeding and the babies will receive their rights.
Keywords: COVID-19 pandemic, elements, breastfeeding, strengthening, weakening
... The application of the complete protocol is recommended after the baby completes one month of age, at which time breastfeeding can be considered as well established (four to six weeks). 25 In this study, the retest was applied using the full version of the NTST after 15 days, which is shorter than the 30 days recommended by Martinelli et al. 24 The results of the present study indicate that breastfeeding can and should be checked at 15 days, a time point that is extremely important for decreasing the chances of early weaning. 26 As already shown, early intervention is important to prevent this from occurring. ...
Purpose: Ankyloglossia is a congenital anomaly that restricts tongue movements and can interfere in breastfeeding. The purpose of this study was to compare two protocols for ankyloglossia diagnosis: (1) the Neonatal Tongue Screening Test (NTST); and (2) the Bristol Tongue Assessment Tool (BTAT). Methods: This was a cohort study involving live births at the University Hospital of Brasilia, Brasilia, Brazil, from August 2017 to July 2018. The gathered data were based on clinical examinations and interviews with mothers. The Stata software program was applied to conduct the analyses using the chi-square test, Spearman's correlation and the receiver operating characteristic (ROC) curve, and sensitivity, specificity, and positive and negative predictive values. Results: A total of 972 mother-baby dyads were evaluated. The protocols showed agreement (P ≤ 0.001) for an ankyloglossia diagnosis, according to Spearman's correlation. The prevalence of ankyloglossia was 5.5 percent (NTST) and 5.1 percent (BTAT) and was greater in the male gender in both protocols. According to the ROC curve, the four cutoff point showed better sensitivity and specificity (98.4 percent and 64.2 percent, respectively). The BTAT was highly accurate in comparison with the NTST. Conclusions: Both protocols showed similar low ankyloglossia prevalence. The Bristol Tongue Assessment Tool protocol is potentially more viable as a screening instrument than the Neonatal Tongue Screening Test protocol because it is simpler and more concise.
... We also observed earlier initiation of breastfeeding in the post-intervention and this earlier initiation increased the odds that an infant was discharged exclusively feeding on breastmilk. This is consistent with other literature as it is well known that if milk removal does not occur either by infant suckling or expression by hand or pump, milk secretion will start to decline around day three postpartum [22,23]. A study from the United States comparing milk expression within one hour after delivery to within 1-6 h after delivery showed that the earlier expression group had earlier lactogenesis stage II (transition from colostrum to copious breast milk production) and resulted in higher milk volume [24]. ...
Background
Early initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding.
Methods
This pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge.
Results
Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge.
Conclusions
Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.
... Apabila ibu makan secara teratur dan cukup mengandung gizi yang diperlukan akan dapat memengaruhi produksi ASI, karena kelenjar pembuat ASI tidak dapat bekerja dengan sempurna tanpa makanan yang cukup. Kebutuhan kalori ibu tiap hari harus terdiri atas 45 ̶ 60% karbohidrat, 10 ̶ 35% protein, dan 20 ̶ 35% lemak (Botha et al., 2018), (Kent et al., 2012). Penelitian lain menunjukkan Peningkatan kuantitas ASI berbeda signifikan antara kelompok yang diberikan ekstrak daun kelor dan tepung daun kelor (masingmasing 263±41vs.151±9,p=0,40). ...
Tujuan penelitian ini untuk mengetahui adanya pengaruh kukis ekstrak daun kelor terhadap produksi ASI dan berat badan bayi. Metode penelitian yang digunakan adalah Studi Observasional prospektif dengan pretest-posttest control group design. Jumlah responden sebanyak 72 ibu nifas, terdiri atas 36 responden kelompok perlakuan dan 36 responden kelompok pembanding. Penelitian dilakukan pada bulan Juli-Agustus 2018 di 4 klinik yang ada di Kabupaten Bekasi. Peneliti menggunakan uji Wilcoxon dan Mann Whitney. Hasil penelitian menunjukkan bahwa setelah pemberian kukis ekstrak daun kelor selama 14 hari terdapat peningkatan produksi ASI pada kelompok perlakuan sebanyak 112,5 mL dan pada kelompok pembanding 45 mL (p=0,00). Nilai median sebelum diberikan pada kelompok perlakuan 72,5 mL dan setelah diberikan kukis menjadi 185 mL. Peningkatan berat badan bayi pada kelompok perlakuan 575 gram, pada kelompok pembanding 225 gram (p=0,00). Nilai median sebelum diberikan kukis pada kelompok perlakuan 2.700 gram dan setelah diberikan kukis menjadi 3.275 gram. Hal tersebut menunjukkan pengaruh pemberian kukis ekstrak daun kelor terhadap produksi ASI dan berat badan bayi. Simpulan, terdapat pengaruh pemberian kukis ekstrak daun kelor terhadap produksi ASI dan berat badan bayi. Hal tersebut dapat dijadikan acuan bahwa pemberian kukis ekstrak daun kelor dapat dijadikan makanan alternatif atau tambahan untuk meningkatkan produksi ASI dan berat badan bayi. Bidan dapat menyampaikan manfaat kukis ekstrak daun kelor tersebut pada saat melakukan pelayanan kebidanan.
... Mothers who feel stressed about their milk production should be helped to release it using relaxation techniques such as deep breathing, gentle massage, and listening to their favorite music to encourage the milk ejection reflex. 15 Another advantage is that the herbs used as raw materials for compresses contain essential oils that function as aromatherapy. ...
Background: Breast milk is the best food for babies, needed for optimal growth and development. The lack of milk production influences the low coverage of exclusive breastfeeding. Increasing breast milk production could be done non-pharmacologically, using warm herbal compresses as breast care.
Purpose: Analyze the effect of warm herbal compresses as breast care on oxytocin hormone and postpartum mother's milk production.
Methods: Quasi-experimental design pretest-posttest with the control group, respondents were 36 normal mothers on the third day of postpartum; 18 respondents intervention group, and 18 respondents control group. Warm herbal compresses were provided once per day with 20 minutes on each breast for three days. The oxytocin hormone was measured pre and post three days of treatment, the volume of breast milk was measured pre, post 2, and 3 days of treatment.
Results: The intervention group's average difference in oxytocin hormone was 24.65 pg/ml, the control group was 2.48 pg/ml (p
... Many of these herbal medicines have gained popularity in the Western and other Asian countries as galactagogues. In our study, the increase of milk production in lactating mice might be due to proliferation and activity of mammary epithelial cells which in turn is due to the action of the extract on mammary glands and hormones involving in lactation like prolactin [40][41][42]. We also found that there were some complexes with potent antioxidant properties and are phyto-estrogenic in nature, such as β-sitosterol. ...
Introduction
Pergularia daemia (Forssk.) Chiov. [PD] is used as a galactagogue by various tribes in Purulia district, India, lacks a scientific basis.
Objectives
The purpose of the study was to determine whether administration of aqueous leaf extract of P. daemia can increase milk production in lactating mice and encourages development in suckling pups.
Methods
30 lactating mice (n=6 per group) with a minimum of 5 pups each were treated with the aqueous PD extract at 50, 100, 150 and 200 mg/kg body weight while the control group was administered with only distilled water. The mice were daily fed with aqueous leaf extract via gavage, which started at day 3 and continued to day 15 post-partum and milk secretion was assessed by the weight-suckle-weight method. The qualitative estimation, UV-vis analysis and GC-MS study of the leaf extract was also done for the presence of phytoconstituents.
Results
Administration of aqueous leaf extract led to a considerable increase in milk production (28.1%) and the pups gained weight substantially ( p <0.05) when compared to control. Milk production was enhanced in mice treated with 150 mg/kg b.wt. of leaf extract compared to other doses ( p <0.05). The GC-MS analysis of the aqueous leaf extract of P. daemia revealed 20 major peaks, some with small retention time and also revealing presence of several phyto-estrogenic compounds.
Conclusion
The present study effectively demonstrated that aqueous leaf extract of PD enhanced milk production in mice and might be used as an alternative strategy for increasing milk production and can be extrapolated to farm animals and human beings.
... For the first breastfeed, within 60 minutes of birth, infants take 0 to 5 mL of colostrum. For the first 2 days after birth, before secretory activation, the intake of colostrum is 37 to 169 mL/d (4). This is because there is still a small amount of progesterone, estrogen, Human Placental Lactogen (HPL) and ...
p> Background: Breastmilk production on the 2nd to 3rd day after delivery is still low and it can lead to breastfeeding adequacy problem. Hormonal constitute one of many factors that causing this condition. Therefore, there is a need for non-pharmacological interventions to increase breastmilk production in primpipara postpartum mothers.
Objectives: The purpose of the study was to determine the effect of the SPEOS method (stimulation of endorphins, oxytocin, and suggestive massage) and classical music therapy on breastmilk production in primipara postpartum mothers.
Methods: This study was a quasi-experiment with pretest and post-test with control group design. A total of 34 postpartum mothers from the first day to the fourth day were selected in this study randomly and were divided into an experimental group (EG) and control group (CG). Wilcoxon and Mann Whitney test was used for statistical analysis.
Results: The average breastmilk production after the administration of the SPEOS method and music therapy interventions was increased significantly from 4.35 ml to 46.66 ml (p=0.0001) compared to control group 5.48 ml to 19.07 ml (p=0.0001).
Conclusions: The combination of the SPEOS method and music therapy is effective in increasing breastmilk production in primipara postpartum mothers. </p
... Specifically, mothers producing less than 140 mL/ day of breast milk on day 4 after delivery were almost 10 times more likely to suffer from inadequate milk production at 6 weeks postpartum [28]. Milk production is enhanced by early breast stimulation (within 1-6 h post birth) and frequent milk removal with a hospital-grade electric breast pump thereafter [29,30]. This critical time period of transitioning to secretory activation (lactogenesis II) and production of quantities of breast milk sufficient for exclusively breastfeeding infants has been termed "coming to volume" [31,32]. ...
Introduction
No studies have determined if there is a threshold whereby use of mother’s own milk (MOM) during hospitalization predicts exclusive MOM feeding at discharge.
Methods
Among 113 very low birthweight neonates, the ratio of MOM to enteral feeds was measured in the first 14 days, 28 days, and overall hospital stay. The primary outcome was exclusive MOM feeding at discharge.
Results
For every 1% increase in MOM consumption in the first 14 and 28 days, the odds of being discharge home on an exclusive MOM diet increased nearly 7-fold (OR 7.01, 95% CI: 2.09–23.50) and 17-fold (OR 17.46, 95% CI 4.67–63.31), respectively. A threshold of >50%, >83%, and >85% MOM consumption compared to overall enteral feeds in the first 14 days, 28 days, and throughout hospitalization, respectively, is recommended.
Conclusions
Promotion of MOM consumption in the first 2–4 weeks is of paramount importance, with negligible impact of increasing MOM consumption after 28 days.
... Anise (P. anisum) can be used to increase the amount of milk (Kent et al., 2012), for constipation and irritable bowel syndrome (Mercadante et al., 2011;Mosaffa-Jahromi et al., 2016), and to induce sleep (Marinov and Valcheva-Kuzmanova, 2015). Peppermint (M. ...
The use of herbal products by pregnant and lactating mothers without awareness of their harmful effects may expose both mother and fetus or infant to great dangers, such as abortion, premature delivery, uterine bleeding, and physical and mental retardation of the fetus. Thus, the aim of this study was to investigate the extent to which herbal product treatment is used and the reason for which such products are used and to ensure that these reasons are correct. An ethnopharmacological survey (cross-sectional observational design study) using a pre-piloted questionnaire was undertaken on herbal products used by pregnant and lactating women in the West Bank area of Palestine. A questionnaire was distributed to 350 pregnant and lactating women. The informed consent forms, ethics, and aims of the present study were reviewed and approved by the Institutional Review Board (IRB) at An-Najah National University. To identify the most important species used, the use value (UV) index was employed, while the SPSS program was used to analyze the data. Collected data revealed that 13 medicinal plants are utilized, while 12 plants are not used during pregnancy. Moreover, 15 plants are utilized and 9 plants are not used during lactation for treating and dealing with various problems. The most commonly used plants belonged to 14 families, including Lamiaceae, Apiaceae, Leguminosae, and Rubiaceae. The plants most used during pregnancy were sage (Salvia fruticosa), anise (Pimpinella anisum), and peppermint (Mentha × piperita). Castor (Ricinus communis) oil, ginger (Zingiber officinale), saffron (Crocus sativus), and senna (Senna alexandrina) mostly were not used by pregnant women. Moreover, cinnamon (Cinnamomum verum), anise (P. anisum), peppermint (M. piperita), and sage (S. fruticosa) were mostly used during lactation. Castor (R. communis) oil, ginger (Z. officinale), garlic (Allium sativum), and aloe (Aloe vera) mostly were not used during lactation. This study is of great importance in order to decrease the possibility of endangering the lives of fetuses and infants. A combined effort among researchers, scientists, lactating women, and pregnant women may help in changing wrong uses and thoughts about medicinal plants and help to improve the overall health of both mother and fetus.
... Interestingly, the women in the current study with higher concentrations of niacin, pantothenic acid, vitamin B-12, and choline in early lactation had a significant decrease in these vitamins at later lactation stages compared with the women who started with lower concentrations. Because one of the main factors regulating milk production is infant demand (36,37), this finding could point toward a physiological mechanism. Infants may send signals to their mothers during breastfeeding, adjusting the milk composition to their requirements. ...
Background
Little is known regarding the associations between maternal factors and B-vitamin and choline concentrations in early milk and the trajectories of these vitamins during lactation.
Objectives
In this hypothesis-generating study, we modeled the association between maternal and offspring factors and longitudinal changes in milk B-vitamin and choline concentrations throughout lactation.
Methods
A hundred women were studied in a prospective birth cohort and milk samples from 52 women were collected at 2–8 d, 76 women at 28–50 d, and 42 women at 88–119 d postpartum. Maternal dietary intake during pregnancy and lactation was assessed by an FFQ. Linear mixed-effects models with interaction terms were used to evaluate changes in milk B-vitamin and choline concentrations over time based on maternal factors and the early postpartum concentrations of these micronutrients.
Results
The women with higher early postpartum milk concentrations of niacin (βinteraction = −0.02; SE = 0.00; P < 0.001), pantothenic acid (βinteraction = −0.10; SE = 2.56; P < 0.001), vitamin B-12 (βinteraction= −0.10; SE = 0.03; P < 0.001), and choline (βinteraction= −0.90; SE = 0.18; P < 0.001) exhibited a decrease in their concentrations throughout lactation. The participants with overweight and obesity prepregnancy experienced an increase in milk vitamin B-12 concentrations over time (βinteraction = 0.04; SE = 0.02; P = 0.06). In contrast, a decrease in vitamin B-12 concentration was observed among women with vitamin B-12 intake below the RDA during pregnancy (βinteraction= −0.08; SE = 0.05; P = 0.07). The women with niacin intake below the RDA during lactation experienced an increase in milk concentrations over time (βinteraction = 0.01; SE = 0.01; P = 0.03). A gestational age at birth >40 wk was associated with an increase in milk choline concentration throughout lactation (βinteraction = 0.54; SE = 0.16; P< 0.01).
Conclusions
Changes in B-vitamin and choline concentrations in human milk over time may be associated with the early concentrations of these micronutrients in milk, maternal prepregnancy BMI, dietary intake, and gestational age at delivery.
... Accordingly, treatment options could be supported as a secondary option. 10 Pharmacological galactagogues are substances used to induce, maintain, and increase milk production. 11 Domperidone is frequently regarded as the drug of choice; however, it is not licensed for use in the USA, 11 but is marketed in the UK and Canada. ...
Insufficient milk production is cited as the important reason for early termination of breastfeeding. Massage is an effective and low-risk treatment choice for promoting milk secretion. However, previous systematic reviews of the literature have not addressed the methods of massage therapies in terms of effects on milk production among postpartum mothers. This systematic review identified and synthesized massage techniques to increase milk production among Asian mothers. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statements was applied as a guideline for this review. PubMed, CINAHL, Science Direct, Scopus, SAGE Journal, BMJ Journals, and other breastfeeding sources were searched covering English publications from 2009-2020. Experimental research studies were included according to inclusion and exclusion criteria. Screening and data extraction were performed systematically. The methodological quality was assessed using standardized critical appraisal instruments for quantitative studies from the Joanna Briggs Institute. Twenty-two studies from Asian countries were selected to review. Two groups of massage treatments consisted of partial body massage and breast massage. Combined massage techniques appeared to result in more milk volume, however, the existing studies were mostly of low and moderate quality due to unclear risks of bias and having heterogeneous data. The limitation of control group details, diversity of participants characteristics, and small sample size of the included studies prevented the combination of data across studies for meta-analysis. Further research is needed to improve the methodological rigor and standard measurements of milk volume for combining the overall effects of the interventions. Massage techniques can be an interesting choice for sustainable breastfeeding duration, however, massage skills need to be standardized for nurses and included in nurse education programs. © 2020, Thailand Nursing and Midwifery Council. All rights reserved.
... In this study we provide evidence that early lactation problems among women fully breastfeeding precede later reports of PIM. Mothers' perception of increased breastfeeding frequency must shift from a sign of PIM (Kent, Prime, & Garbin, 2012) to a key approach to increasing the volume of breast milk produced, as our findings suggest that perceived lactation problems can diminish with increased breastfeeding frequency. We also provided evidence that decreasing lactation problems are associated with greater alignment with the proximal infant care style. ...
Breastfeeding mothers often report perceived insufficient milk (PIM) believing their infant is crying too much, which leads to introducing formula and the early abandonment of breastfeeding. We sought to determine if infant crying was associated with reported PIM (yes/no) and number of problems associated with lactation (lactation problem score [LPS] 6‐point Likert scale) before formula introduction. Primiparous breastfeeding mothers were recruited at birth and visited at 1, 2 and 4 weeks. Among those fully breastfeeding at 1 week (N = 230), infant crying variables based on maternal reports were not associated with PIM at 1 week, but LPS was. However, a mother's expectation that her infant would cry more than other infants was associated with increased odds of reporting PIM at 2 and 4 weeks, as were delayed onset of lactation and previous LPS. At 1 week, crying variables (frequency, difficulty in soothing) were associated with LPS along with percent weight change. Delayed onset of lactation, infant care style, number of breastfeeds and previous LPS were longitudinally associated with change in LPS from 1 to 2 weeks and 2 to 4 weeks. Our data suggest that reported infant crying is associated with PIM and LPS in the first 4 weeks of life. Guidance on what to expect in crying behaviour and the impact of infant care style may be beneficial in reducing PIM and LPS in the first month.
... We also observed earlier initiation of breastfeeding in the post-intervention and this earlier initiation increased the odds that an infant was discharged exclusively feeding on breastmilk. This is consistent with other studies as it is well known that if milk removal does not occur either by infant suckling or expression by hand or pump, milk secretion will start to decline around day 3 postpartum [21,22]. A study comparing milk expression within 1 hour after delivery to within 1-6 hours after delivery showed that the earlier expression group had earlier lactogenesis stage II (transition from colostrum to copious breast milk production) and resulted in higher milk volume [23]. ...
Background: Early initiation of breastfeeding after birth and ongoing exclusive breastfeeding for the first 6 months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding, aligned with the Baby Friendly Hospital Initiative for small and sick newborns.
Methods: A pre-post quasi experimental study was conducted at two District hospital NCUs in rural Rwanda from October 2017–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data was extracted from patient charts for clinical and demographic characteristics, feeding throughout admission, and patient outcomes. Bivariate analyses were conducted using Fisher’s exact and Wilcoxon rank sum tests. Logistic regression was used to evaluate factors associated with exclusive breastfeeding at discharge following a backwards stepwise procedure.
Results: Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in the post-intervention period. The percentage of infants who were exclusively breastfed on their day of birth, or day-of-life zero (DOL0) increased from 5.4% to 35.9% (p<0.001). For newborns discharged alive, the proportion exclusively breastfeeding increased from 69.6% to 87.0% (p<0.001). The mortality rate for all admitted newborns decreased from 16.1% to 10.5% (p<0.019). Factors associated with greater odds of exclusive breastfeeding at discharge included post-intervention time point (Odds Ratio (OR): 4.91, 95% Confidence Interval (CI) 1.99-12.11, p<0.001), and admission for infection (OR 2.99, 95%CI 1.13-7.93, p=0.027). Home deliveries (OR 0.15, 95%CI 0.05-0.47, p=0.001), preterm delivery (OR 0.36, 95%CI 0.15-0.87, p=0.0260 and delayed first breastmilk feed (OR=0.04 for DOL3 vs. DOL0, 95%CI 0.01, 0.35, p=0.004) reduced odds of exclusive breastfeeding at discharge.
Conclusion: Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns should be expanded and adapted in similar settings to improve outcomes for these infants.
Background:
Regardless of their HIV serostatus, mothers are advised to exclusively breastfeed infants ≤6 mo postpartum. How this guidance impacts breast milk intake among HIV-exposed infants in varied contexts needs to be better understood.
Objectives:
The objective of this study was to compare breast milk intake of HIV-exposed and HIV-unexposed infants at 6 wk and 6 mo of age, as well as the associated factors.
Methods:
In a prospective cohort design, which we followed from a western Kenya postnatal clinic, 68 full-term HIV-uninfected infants born to HIV-1-infected mothers (HIV-exposed) and 65 full-term HIV-uninfected infants born to HIV-uninfected mothers were assessed at 6 wk and 6 mo of age. Breast milk intake of infants (51.9% female) weighing 3.0-6.7 kg (at 6 wk of age) was determined using the deuterium oxide dose-to-mother technique. Student t test for independent samples compared the variations in breast milk intake between the 2 groups. Correlation analysis detected the associations between breast milk intake and maternal and infant factors.
Results:
Daily breast milk intakes by HIV-exposed and HIV-unexposed infants were not significantly different at either 6 wk (721 ± 111 g/d and 719 ± 121 g/d, respectively) or 6 mo (960 ± 121 g/d and 963 ± 107 g/d, respectively) of age. Maternal factors that significantly correlated with infant breast milk intake were FFM at both 6 wk (r = 0.23; P < 0.05) and 6 mo (r = 0.36; P < 0.01) of age and weight at 6 mo postpartum (r = 0.28; P < 0.01). Infant factors that significantly correlated at 6 wk were birth weight (r = 0.27; P < 0.01), present weight (r = 0.47; P < 0.01), length-for-age z-score (r = 0.33; P < 0.01), and weight-for-age (r = 0.42; P > 0.01). At 6 mo, they were infant length-for-age (r = 0.38; P < 0.01), weight-for-length (r = 0.41; P > 0.01), and weight-for-age (r = 0.60; P > 0.01).
Conclusions:
Full-term breastfeeding infants born to HIV-1-infected and HIV-1-uninfected women attending standard Kenyan postnatal care clinics ≤6 mo of age in this resource-poor setting consume comparable amounts of breast milk. This trial was registered at clinicaltrials.gov as PACTR201807163544658.
Resumen
La leche materna, además de la simple nutrición, posee numerosas funciones fisiológicas que las leches maternizadas no pueden proporcionar o lo hacen de manera insuficiente. Muchos estudios muestran que la lactancia disminuye en los más pequeños la prevalencia de infecciones, obesidad infantil, muerte súbita del lactante, enfermedades inflamatorias intestinales y enterocolitis ulceronecrótica del prematuro; además, está asociada a un aumento del cociente intelectual. Es muy probable que también esté asociada a una reducción de las enfermedades atópicas, al menos por lo que se refiere al eccema y a la respiración sibilante antes de los 2 años. En la madre, la lactancia disminuye la prevalencia de los cánceres de mama que no presentan o presentan pocos receptores hormonales, así como del cáncer triple negativo, el cáncer epitelial del ovario, la diabetes tipo 2 y las enfermedades cardiovasculares antes de los 65 años. Los beneficios de la lactancia son de tal importancia que la Organización Mundial de la Salud recomienda para todos los niños una lactancia materna exclusiva hasta los 6 meses, tras la cual se van introduciendo alimentos complementarios, pero manteniendo la lactancia hasta al menos los 12 meses. En Francia, sin embargo, la tasa de lactancia en el 2013 era de tan sólo un 30% a los 4 meses y del 18% a los 6 meses. En una mujer motivada, el éxito de la lactancia depende de medidas sencillas que es importante instaurar correctamente.
ASI merupakan makanan utama bayi sehingga tidak ada jenis makanan lainnya yang dapat menandingi kualitas ASI. Hanya ASI saja yang dapat diterima oleh system pencernaan bayi sehingga ASI harus diberikan secara eksklusif selama 6 bulan. Untuk mengetahui efektifitas pemberian sari kurma terhadap kelancaran ASI ibu postpartum di Puskesmas Minasa Upa Mkassar. Metode penelitian yang digunakan adalah Nonequivalent Control Group Design dan dilaksanakan pada tanggal 15 Juli sampai 15 September 2020. Metode pengambilan sampel yanhg digunakan adalah purposive sampling. Sampel penelitian ini adalah ibu post partum yang ASInya tidak lancar berjumlah 30 responden. Analisa data menggunakan uji Chi-Square (α = 0,05). Berdasarkan hasil uji statistic pada kelompok intervensi didapatkan nilai mean sebelum 1,60 dan mean setelah 2,93 terdapat selisih 1,33 sedangkan pada kelompok control didapatkan nilai mean sebelum 1,80 dan mean setelah 1,93 terdapat selisih yaitu 0,13. Berdasarkan uji Chi-Square kelancaran ASI ibu post partum diperoleh nilai ρ = 0,000. Nilai ρ lebih kecil dari 0,05 (ρ=0,00 < 0,05), maka Ho ditolak dan Ha diterima. Ada efektifitas pemberian sari kurma terhadap kelancaran ASI ibu post partum di Puskesma Minasa Upa Tahun 2020. Maka disarankan agar ibu post partum dapat mengkonsumso sari kurma agar dapat memperlancara ASI ibu post partum yang menyusui, dan diharapkan pada petugas kesehatan malakukan penyulihan tentang manfaat dari kandungan sari kurma.
An ethnobotanical survey was conducted in Katsina state, Northern Nigeria to document medicinal plants commonly used by lactating mothers to boost breast milk production. Two hundred and forty (240) respondents made up of (120) nursing mothers, (60) herbalists and (60) traditional birth attendants were interviewed. Ethnobotanical data was obtained using the structured questionnaire method. Standard procedures were followed to analyse the phyto-chemical, proximate, mineral concentrations and chemical composition of the ethanolic extract of the most cited plants. Forty (40) plant species belonging to 38 genera distributed among 24 families are used as galactagogues in Katsina state, Nigeria. All the plant samples contained alkaloids, cardiac glycosides, flavonoids, saponins, tannins and terpenoids. Anthraquinones were found to be absent in Andropogon gayanus, Moringa oleifera and Pennisetum glaucum while phytosterol was absent in Pennisetum glaucum and Vernonia amygdalina. They were also found to contain nutrient compositions in varying amounts. Crotalaria retusa had the highest moisture (12.80%), crude lipid (13.50%) and crude fibre (21.76%) content. Momordica balsamina has the highest ash (13.76%) content. Pennisetum glaucum had the highest carbohydrate content (76.19%) and energy content (364.95%). Mineral analysis revealed that Andropogon gayanus, Momordica balsamina and Vernonia amygdalina showed equal phosphorus (0.3 ppm) contents. Crotalaria retusa showed the highest chromium (2.59 ppm) and copper (1.31 ppm) content. GC/MS analysis revealed that Momordica balsamina contained 99 phytoconstituents. With only 9,12-Octadecadienoic acid (Z,Z)- identified as the only phytoconstituents showing phytoestrogen activity. The indigenous knowledge about lactating mothers in Katsina state, Nigeria used medicinal plants to boost breast milk production is documented.
This chapter reviews the role of responsive feeding in supporting breastfeeding, as well as the ways in which breastfeeding can reinforce responsive feeding. First, the demand and supply nature of lactation is outlined as a foundation for understanding the role of responsive feeding in supporting breastfeeding success. Next, connections between perceived insufficient milk supply and responsive feeding are elucidated. Finally, effects of breastfeeding on mothers’ responsiveness to infant cues via hormonal, neural, and behavioral mechanisms are discussed. Overall, this chapter highlights the importance of promoting caregivers’ engagement in responsive feeding during the perinatal period as a critical support for breastfeeding and the benefits of breastfeeding for infant feeding and weight outcomes.
This study is laboratory experiment which aimed to invent an effective gel pad which
is effectively equivalent to the standard gel pad with low production cost and can be made
available by health services. The research instruments included synthetic polymer fibers
and water, the equipment for invention, for the temperature test, for compress making,
and for the comparison of properties, the record of the gel pad’s temperature, and the record
of the temperature of the tissue. The study and the data collection were conducted from May
to September, 2014. The processes of the study included: 1) the literature reviews on searching
for the properties and safety materials to invent gel pad, 2) testing on the elements and
proportions of appropriate materials to invent gel pad, 3) testing on performance method
for preparing gel pad, 4) testing on temperature reserve and confinement period between
the invented gel pad and the standard gel pad, 5) testing on the performance of the gel pad
when doing warm compress on the tissues of two female volunteers and 6) experimenting
for the effectiveness on the gel pad when doing warm compress. The data were analyzed
by frequency and mean.
The results of the study revealed that the invented gel pad can be made from synthetic
polymer fibers in finished diapers baby by mixing 60 ml. of pure water into 1 gram of synthetic
polymer. The preparation of the gel pad can be done by soaking gel pad in boiling water
for at least 5 minutes. The suitable gel pad for use was 3-4 grams. It was found that the
invented gel pad was effectively equivalent in reserving temperature to the standard gel pad.
The invented gel pad compress of 4 grams was suitable for a warm compress. It did not
cause irritation to the tissues. It was also found that the invented gel pad can be used 9 times, with an average cost of 13 satangs each time.
According to this study, it is recommended that the health services can use the invented
gel pad in health promotion and nursing therapeutic without the constraint of budget.
Infants who are exclusively breastfed in the first six months of age receive adequate nutrients, achieving optimal immune protection and growth. In addition to the known nutritional components of human breast milk (HBM), i.e., water, carbohydrates, fats and proteins, it is also a rich source of microRNAs, which impact epigenetic mechanisms. This comprehensive work presents an up-to-date overview of the immunomodulatory constituents of HBM, highlighting its content of circulating microRNAs. The epigenetic effects of HBM are discussed, especially those regulated by miRNAs. HBM contains more than 1400 microRNAs. The majority of these microRNAs originate from the lactating gland and are based on the remodeling of cells in the gland during breastfeeding. These miRNAs can affect epigenetic patterns by several mechanisms, including DNA methylation, histone modifications and RNA regulation, which could ultimately result in alterations in gene expressions. Therefore, the unique microRNA profile of HBM, including exosomal microRNAs, is implicated in the regulation of the genes responsible for a variety of immunological and physiological functions, such as FTO, INS, IGF1, NRF2, GLUT1 and FOXP3 genes. Hence, studying the HBM miRNA composition is important for improving the nutritional approaches for pregnancy and infant’s early life and preventing diseases that could occur in the future. Interestingly, the composition of miRNAs in HBM is affected by multiple factors, including diet, environmental and genetic factors.
The current book is an update revision and adaptation of the New BFHI 2018 for the Hospital Materno Infantil, Caja Nacional de Bolivia. More content on baby problems to suck was added. Also we kept the warning signs of pregnancy as well as for the new born.
There are several work-related barriers to breastfeeding among physician mothers including: lack of appropriate place for breastmilk expression, unpredictable and inflexible schedules, and lack of time to breastfeed or express milk. In a survey of physician mothers, those who were in surgical and procedural subspecialties, including anesthesiology, reported a lack of lactation facilities in close proximity to the operating room as a barrier to breastfeeding. Unlike other physicians and clinicians in different health care environments, anesthesiology is unique in that there is often no built-in time for breaks or a predictable end time to the operating room schedule. A break system is typically established, within an institution, for meal break relief for trainees, Certified Registered Nurse Anesthetist, and Anesthesia Assistants. This system for breaks may not be sufficient to accommodate the frequency or length required for lactation sessions. In addition, these break systems do not typically provide relief for supervising anesthesiologists for meals or lactation sessions. A study of physician mothers across specialties identified anesthesiologists as significantly more likely than women of other medical specialties to self-report maternal discrimination. The study defined maternal discrimination as discrimination based on pregnancy, maternity leave, or breastfeeding. As a workforce and specialty, we must support our breastfeeding anesthesiologists and facilitate lactation needs on return to the workplace.
Infant feeding challenges continue to manifest in developed and developing countries. Worldwide, more than 80% of babies are breastfed in the first few weeks of birth. However, about 37%, 25%, and less than 1% are exclusively breastfed at 6 months of age in Africa, the United States of America, and the United Kingdom, respectively. These statistics are far below the World Health Organization targets of 50% and 70% by 2025 and 2030, respectively. Complementary feeding practices are varied as well due to nonadherence to Infant and Young Child Feeding (IYCF) guidelines among parents. This accounts for the current trends in malnutrition in children under−5 years of age, adolescents, and the youth, and leads to intergenera-tion malnutrition. In this chapter we have included sections on appropriate infant feeding; including how to initiate breastfeeding in the first hour of birth, how to exclusively breastfeed infants until 6 months of age, how to complement breastfeed-ing after 6 months of infant's age as well as continuing to breastfeed until 24 months of age and even beyond. Furthermore, we have included a description of how mothers who are unable to breastfeed can feed their infants on expressed breastmilk or replace breastmilk with appropriate homemade or commercial formula. This chapter as well covers infant feeding in prematurity.
Study design:
Narrative review.
Objectives:
To evaluate the availability and quality of breastfeeding guidelines for women with spinal cord injury (SCI).
Setting:
International Collaboration on Repair Discoveries (ICORD), Department of Medicine, Vancouver, BC.
Methods:
An environmental scan restricted to English language literature was performed to identify existing postpartum and breastfeeding guidelines. Guidelines were evaluated using a structured, validated tool (AGREE II) by 13 appraisers [medical/research experts (n = 10) and those with lived experience (n = 3)] from Vancouver and two international sites. Seven guidelines were evaluated across Domain 1 of the AGREE II tool to determine if they were applicable to mothers with SCI/physical disabilities. Domains 2 to 7 were evaluated if the guideline made mention of the SCI population.
Results:
Of the seven guidelines evaluated, only one mentioned SCI (Postpartum Care in SCI from BC Women's Hospital). Other guidelines were excluded from further evaluation as they did not address the issue of breastfeeding in women with SCI. The overall scaled score for this guideline was 34.5%. There was significant variability between domains but no AGREE II domain scored greater than 50%, indicating substantial limitations.
Conclusions:
Current breastfeeding guidelines are not targeted to persons with SCI. The one guideline that made mention of women with SCI had significant global deficits. This highlights the importance of developing guidelines for health care providers focused specifically on women with SCI to support and optimize breastfeeding in this unique population for the benefit of mother and infant across the lifespan.
Background
Common approaches to manage breastfeeding problems such as pain, blocked ducts, and milk production issues include breast compression, breast massage, application of warmth or cold, medications, and breastmilk expression. Several devices are available to apply heat or cold to the breast, however, none promote breast compression and/or massage simultaneously. A new device ‘Lactamo’ has been developed to address this.
Methods
This study was a pre-market evaluation of the Lactamo device. The aims were to determine user safety, and satisfaction of Lactamo. The study was conducted in an Australian tertiary maternity hospital in 2019–2020. Women who were less than 3 months post-partum and were currently breastfeeding participated in the study. We conducted structured telephone surveys at 1 and 4 weeks post supply of Lactamo. Questions included demographic information, feedback on safety, usage, and perceived benefits of Lactamo.
Results
The cohort (n = 30) consisted of equal number of primiparous and multiparous women, 50% were born in Australia and the remainder from 11 other countries. A total of 41 telephone surveys were conducted with 27 women. Of these, 26 (96%) had used Lactamo, and the one that did not, felt she did not have a lactation concern to warrant using it. All women indicated that the device was safe to use and had no concerns, apart from one woman who experienced itching because of the device but continued to use it over clothing as she found it beneficial. Most women used it at room temperature or warmed. The frequency of use varied from once per week (17%) to daily (33%), and use was often prompted by a lactation concern such as engorgement, pain, blocked ducts, and low supply.
Conclusion
Lactamo was found to be safe, and a valuable aid for breastfeeding women. More research is needed to understand the efficacy of the device in treating breastfeeding problems such as pain, blocked ducts, and milk production issues.
Background: The World Health Organization recommends exclusive breastfeeding for ≥6 months, but many mothers are unable to meet this goal. A major reason why mothers undergo early, unplanned breastfeeding cessation is perceived inadequate of milk supply (PIMS). We hypothesized that defining genetic polymorphisms associated with PIMS could aid early identification of at-risk mothers, providing an opportunity for targeted lactation support. Materials and Methods: This prospective observational cohort study followed 221 breastfeeding mothers for 12 months, collecting medical, demographic, and breastfeeding characteristics. Eighteen mammary secretory genes were assessed for single-nucleotide polymorphisms in 88 women (45 with PIMS and 43 with perceived adequate milk supply [PAMS]), matched by age/race/parity. Hierarchical regressions were used to assess the ability of genotype to aid PIMS prediction. Results: Mothers with PIMS exclusively breastfed for a shorter period (7 ± 12 weeks; p = 0.001) and reported lower milk production (17.6 ± 13.3 oz/day; p = 0.001), and their infants displayed reduced weight-for-length Z-score gains (0.74 ± 1.4; p = 0.038) relative to mothers with PAMS (22 ± 19 weeks; 27.03 ± 12.2 oz/day; 1.4 ± 1.5). Maternal genotype for the rs2271714 variant within milk fat globule EGF and factor V/VIII domain containing gene (MFGE8) was associated with PIMS status (p = 0.009, adjusted p = 0.09, likelihood ratio = 9.33) and duration of exclusive breastfeeding (p = 0.009, adjusted p = 0.09, χ2 = 9.39). Addition of MFGE8 genotype to a model employing maternal characteristics (age, parity, previous breast-feeding duration, body mass index, education, and depression status) significantly increased predictive accuracy for PIMS status (p = 0.001; χ2 = 13.5; area under the curve = 0.813 versus 0.725). Conclusions: Genotyping one lactogenic gene aided identification of mothers at risk for PIMS. If validated in a larger cohort, such an approach could be used to identify mothers who may benefit from increased lactation support.
Objective To examine relationships between nipple pain scores and 24 h milk production volumes, breastfeeding and pumping frequencies, and breastfeeding duration in women using nipple shields for persistent nipple pain.
Design Secondary outcome analysis of a prospective cohort study.
Setting Research laboratory (monitored feeds) and participants’ homes (milk production).
Participants Twenty-five breastfeeding women (6±4 weeks postpartum) using nipple shields for persistent nipple pain.
Methods A randomized trial was conducted to investigate the primary outcome of milk transfer with and without nipple shield use in participants with and without nipple pain. Here we report secondary outcomes of associations between 24 h milk production, breastfeeding and pumping frequencies, breastfeeding durations and intake in participants using a nipple shield for nipple pain. Participants completed demographic, health and breastfeeding questionnaires, and at two monitored breastfeeding sessions completed the pain visual analogue scale (VAS), and Brief Pain Inventory – Short Form (BPI-SF total, and subcategory scores for pain interference with general activity, mood, sleep, and breastfeeding). Milk production (mL/24 h), feed volumes, and percentage of available milk removed (PAMR) were calculated from data and milk samples obtained by participants over one 24 h period and at study visits. Participants logged 24 h data on a customised research website. We used descriptive statistics, simple and multiple linear regression for analyses.
Results Milk production and feeding duration were not associated with nipple pain scores (VAS p = .80; BPI-SF p = .44). An increase in BPI-SF breastfeeding subcategory score of one unit, indicating pain interference with breastfeeding, was associated with a 0.28 decrease in breastfeeding frequency (p = .02), and an 18.8 mL decrease in 24 h breastfeeding intake (p = .04).
Conclusion We found no association between nipple pain intensity and milk production or feed duration. Persistent nipple pain was associated with reduced breastfeeding frequency, therefore continuing professional support is required to ensure adequate milk removal and pain management.
Purpose:
Maternal self-confidence facilitates infant growth and new mother role development. Infant ability to breastfeed and maternal breastfeeding self-confidence are imperative to helping mothers meet their breastfeeding goals. Consistent opportunity for infant movement in the prone position has been shown to improve breastfeeding ability; however, families report a lack of knowledge of how to safely support this activity. Perceptions of maternal self-confidence, infant development, and breastfeeding success upon completion of an infant prone positioning program with focus on posture, movement, and connection were studied.
Study design and methods:
Qualitative interviews were conducted among breastfeeding mothers in three states to explore maternal perceptions of learning about infant prone positioning.
Results:
Thirty-five mothers who completed an infant prone positioning program shared their perceptions of infant interaction, prone play and positioning, and breastfeeding self-confidence. Four primary themes were identified from the analysis: maternal knowledge and self-confidence; strategies and practices learned; breastfeeding benefits of infant prone positioning; and motivation for program participation.
Clinical implications:
Our findings support consideration of teaching new mothers about prone positioning to enhance self-confidence in mothering, breastfeeding skills, infant development, and maternal-infant dyad bonding.
Background:
Breast care is an important routine during pregnancy and breastfeeding. Its absence leads to inadequate milk production before and after childbirth.
Objective:
This study aimed to determine the status of breast care during pregnancy, which is related to milk production and disease after childbirth in the Tinggede Health Center, Sigi Regency, Central Sulawesi.
Methods:
The method used was an analytic survey with a cross-sectional approach and the samples were 82 breastfeeding mothers in the working area of the Tinggede Health Center. The sampling used a total population, and data were obtained by interview and observation. Furthermore, the analysis technique used Chi-Square.
Results:
The results showed there was a relationship between breast care during pregnancy with milk production (p = 0.001), and breast care status with a disease (p = 0.012). The common diseases suffered by breastfeeding mothers due to inadequate care are non-protruding nipples, infections, blocked milk ducts, mastitis, and lumps.
Conclusions:
Breastfeeding mothers' failure to care for their breasts during pregnancy can lead to lack of milk production and diseases such as non-protruding nipples, infections, blocked milk ducts, mastitis, and lumps.
Introduction:
Mother's own milk improves health outcomes in infants of all gestational ages. Although pump-dependent mothers of extremely premature infants are at risk of insufficient milk production, whether mother's milk production is impacted by gestational age and pump dependency in mothers of more mature critically ill infants is unknown.
Purpose:
To determine whether there is a relationship between gestational age, milk production, and time to secretory activation in mothers delivering a critically ill infant.
Methods:
A convenience sample of 136 pump-dependent mothers whose infants were admitted to the neonatal intensive care unit was enrolled between 2013 and 2016 as part of a quality improvement project. Group 1 (early preterm) delivered infants at 30 to 33 weeks of gestation (n = 41), group 2 (late preterm) 34 to 36 weeks (n = 48), and group 3 (term) 37 weeks and more (n = 47). Milk volume on days 1 to 7 was measured by weighing each vial of expressed milk and compared using general linear mixed-model analysis. Time to the onset of secretory activation was compared using censored regression analysis.
Results:
Main effect for gestational age controlling for day was statistically significant (P = .0234). The early preterm group produced more milk over the 7-day study than the term (P = .01) and late preterm (P = .02) groups. The early preterm group achieved secretory activation earlier than the late preterm group (adjusted P = .039).
Implications for practice:
Pump-dependent mothers of all infants admitted to the neonatal intensive care unit may be at risk of inadequate milk production and delayed secretory activation and may therefore benefit from early milk production monitoring and lactation support.
Implications for research:
Further studies should examine targeted interventions to increase milk production in pump-dependent mothers.
Objective: To assess the level of knowledge and to explore out the perceptions of expecting and lactating women about Exclusive breastfeeding attending Ayub Teaching Hospital, Abbottabad. Study Design: A Mixed Method Study. Place and Duration of Study: Ayub Teaching Hospital, Abbottabad, from Jul 2018 to Dec 2018. Material and Methods: The study was carried out by using non-probability convenience sampling on 354 women who visited Gynaecology and Obstetrics department of Ayub Teaching Hospital, Abbottabad. Quantitative data was collected by using a semi structured questionnaire developed with the help of literature review whereas the qualitative data was collected by using a qualitative interview guide. Frequencies and percentages were computed and chi-square was used to find associations between socio-demographic status of women and their knowledge and perceptions about exclusive breastfeeding. In-depth interviews were conducted to explore the perceptions of women about exclusive breastfeeding. Age, Education, Area of residence, Family income and Parity are Independent variables while Knowledge and Perceptions about exclusive breastfeeding are the dependent variables. Results: The ages of respondent women ranged from <20 years to 50 years with the majority belonging to the 31-40 years age group (46%, n=165). Most (63%, n=225) of the children"s age was 0-6 months, Majority (41%, n=145) of the women"s qualification was matriculation. Majority (68%, n=244) of the women were multiparous and more than a half were unemployed (62%, n=222). Also the major portion of sample belonged to the rural areas. The sample predominantly belonged to middle and low-income group with a moderate level of education. Only 35% (n=124) of the women had good knowledge about the feed of a newborn up to 6 months of age. More than half (56%, n=200) of the women think that Ghutti is the best way to start feeding a newborn. About 48% (n=171) of the respondent women were able to define exclusive breastfeeding correctly. Conclusion: There is need for large scale health enlightenment of members of the public on EBF and its benefits to the infant, mother and society at large. The content of antenatal health talks with respect to EBF and it understanding by women requires evaluation. There is also the need for periodic refresher training of community health workers on the practice of EBF and strategies introduced for regular monitoring and evaluation of the practice. Behavior change communication (BCC) and counseling should be provided to pregnant women during antenatal visits.
THE EFFECT OF GIVING MORINGA CAPSULES ON BREAST MILK PRODUCTIONBackground In Indonesia, the proision of breastfeeding eclusiely for si months just reached 30.2% case is still far from the target that 80% regard it in because of lack of awareness of society in encouraging an increase in the proision of breastfeeding eclusiely , lack of knowledge of mothers , families and communities about the importance of breastfeeding eclusiely . The purpose of this study was to determine the effect of morngaoliefera leaf capsules on breast milk production in the working area puskesmas of Gedung Sari Lampung entral Health enter in 2019.Methods
This type of uantitatie research with a research design using a pre experimental approach with a pretest and post test with control group design . Samples of all nursing mothers were 40 people. The population of breastfeeding mothers is 79 people. 20 people as a group eperiment and 20 people as a group control with the techniue of sampling purposive sampling .Anilsa the data to test T-test independent.Results of the study is to show the aeragefreuency before administration of the capsule leaes of oringa to the production of breast milk in the region work PuskesmasGedung Sari entral Lampung in 2019 ie 26.50 , the aeragefreuency after administration of the capsule leaes of oringa to the production of breast milk in the region work Puskesmasuilding Sari Lampung The middle of 2019 is 80.50 , and there is an influence of giingoringa leaf capsules to the production of breast milk in the working area of the Sari Lampung entral Health enter in 2019 . ConclusionT test results obtained p value 0,000 <α (0 , 05 there is an effect of consumption of Moringa leaf capsules on milk production). Suggestions for the public are expected that mothers want to consume Moringa leaf capsules in accordance with the recommendations because Moringa capsules can increase milk production.eKeywords : Moringa leaf capsules giving, Production ASI Abstrak Latar Belakang Di Indonesia pemberian ASI eksklusifselamaenambulanbarumencapai 30,2% halinimasihjauhdari target yaitu 80% halini di karenakan rendahnya kesadaran masyarakat dalam mendorong peningkatan pemberian ASI eksklusif, kurangnya pengetahuan ibu, keluarga serta masyarakat tentang pentingnya ASI eksklusif.Tujuan dari penelitian ini adalah mengetahui pengaruh pemberian kapsul daun kelor terhadap produksi ASI di wilayah kerja Puskesmas Gedung Sari Lampung Tengah Tahun 2019. Metode Jenis penelitian kuantitatif dengan rancangan penelitian menggunakan pendekatan pre experimental dengan rancangan pretest dan post test with control group. Populasi ibu menyusui sebanyak 79 orang. Sampel seluruh ibu menyusui sebanyak 40 orang. 20 orang sebagai kelompok eksperimen dan 20 orang sebagai kelompok kontrol dengan teknik sampling purposive sampling. Analisa data dengan uji T-test independent.Hasil penelitian ini menunjukan rata-rata frekuensi sebelum pemberian kapsul daun kelor terhadap produksi ASI di wilayah kerja Puskesmas Gedung Sari Lampung Tengah Tahun 2019 Tahun 2019 Yaitu 26.50, rata-rata frekuensi sesudah pemberian kapsul daun kelor terhadap produksi ASI di wilayah kerja Puskesmas Gedung Sari Lampung Tengah Tahun 2019 Yaitu 80.50, serta ada pengaruh pemberian pemberian kapsul daun kelor terhadap produksi ASI di wilayah kerja Puskesmas Gedung Sari Lampung Tengah Tahun 2019 .Kesimpulan ada pengaruh konsumsi kapsul daun kelor terhadap produksi ASI.Saran untuk masyarakat diharapkan para ibu mau mengkonsumsi kapsul daun kelor sesuai dengan anjuran karena kapsul kelor dapat meningkatkan produksi ASI.Kata kunci : Pemberian Kapsul Daun Kelor, Produksi ASI
Study Objective
: To describe the number of admissions of pregnant adolescents to U.S. juvenile residential systems (JRS) and the outcomes of pregnancies that ended while in custody.
Design
: Prospective study.
Setting
: Three non-randomly selected JRS in three U.S. states.
Participants
: Designated reporter at each JRS reporting aggregate data on various pregnant admissions, outcomes, and systems’ policies.
Interventions
: None.
Main Outcome Measures
: Monthly number of pregnant people admitted, pregnant people at the end of the month, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopics, maternal and newborn deaths, and administrative policies.
Results
: There were 71 admissions of pregnant adolescents reported over 12 months from participating JRS. At the time of the census, six out of the 183 female adolescents (3.3%) were pregnant. Eight pregnancies ended while in custody. Of these, one pregnancy was a live full-term birth, four were miscarriages, and three were induced abortions. There were no newborn deaths or maternal deaths. Administrative policies and services varied among the JRS. For example, all JRS had a prenatal care provider on-site, whereas two JRS helped cover the costs of abortions.
Conclusion
: This study was the first to report the estimates of pregnancy and pregnancy outcomes among justice-involved youth in JRS. Our findings indicate that there are pregnant adolescents in JRS and the vast majority return to their communities while pregnant, highlighting the importance of continuity of care. More work is needed to understand the complexities of health care needs of justice-involved pregnant youth during and after their incarceration.
Rationale and Objectives
Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals.
Materials and Methods
A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption.
Results
50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (p = 0.028). No other factors were statistically significant (p > 0.05).
Conclusion
Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.
Milk secretion is modulated by local chemical feedback inhibition, a mechanism that matches supply of milk to the demand. An inhibitor of milk secretion that is present in milk plays a major role in this inhibition. It is a constituent of the whey proteins, and its moleculars mass is in the range of 10,000-30,000 Da.
The mammary gland is controlled at two levels in the body. The genetically controlled pattern of parental investment during lactation is modified by nutritional status and signalled to the mammary gland by the endocrine system (see Peaker 1989). The response to this strategic control of the rate of milk secretion is modulated by a tactical control mechanism operating within each mammary gland. The local intramammary mechanism responds to changes in the frequency or completeness of milk removal and acts to match the rate of milk secretion to the rate of milk removal by the young or, in dairy animals, by the milker. It is the local control of milk secretion by milk removal which has been uncovered in recent years, following the realization of the physiological significance of unilateral effects of frequent milking in goats (Linzell & Peaker 1971) and cows (Morag 1973) that is the subject of this brief review.
The effect of using a warm breastshield on the efficiency, effectiveness, and comfort of expressing milk with an electric breast pump was assessed. The authors tested a standard breastshield at 25°C and a breastshield warmed to 39°C on 25 mothers using their maximum comfortable vacuum or -125 mm Hg. Using a warm breastshield effectively warmed the nipple and areola and, combined with maximum comfortable vacuum, decreased the time to remove 80% of the total milk yield and increased the percentage of available milk removed after 5 minutes of expression, with no change in the percentage of available milk removed after 15 minutes of expression compared with an ambient-temperature breastshield. The data confirmed that use of the mother's maximum comfortable vacuum was more efficient than a vacuum of -125 mm Hg. Using a warm breastshield with an electric breast pump was comfortable and improved the efficiency of milk removal.
To investigate the dynamics of milk removal during breast expression.
This study used a continuous weighing balance to determine changes in milk flow rate and their relationship to the proportion of milk removed over time and the percentage of the available milk removed during simultaneous expression (15 minutes) of the left and right breasts in 34 mothers of healthy, term, breastfeeding infants.
Multiple milk ejections (5.1±2.0; range, two to 14) were detected as increases in milk flow rate. A larger total expression volume was associated with a higher maximum milk flow rate (p<0.001). However, 14% less of the available milk was removed for a 100 g increase in available milk (p<0.001). After 2.9±1.4 and 6.0±2.5 minutes, 50% and 80%, respectively, of the total expression volume was removed. Milk flow was more active in the first 7 minutes than the last 7 minutes. At the eighth minute (midpoint), 54±25% of the available milk and 86±9% of the total expression volume were removed.
The maximum milk flow rate was predictive of the total volume expressed. After the eighth minute of expression the milk flow rate was reduced. Increasing volumes of milk in the breast were associated with less complete breast emptying. These data suggest that long expression sessions are not required for mothers who are not pump dependent and that extending intervals between expressions results in less effective milk removal.
A 6-month-old term boy was hospitalized to evaluate the cause of his failure to thrive, mandated as part of an investigation by the Department of Children and Families after an allegation of medical neglect was made. On admission the patient was below birth weight, and a medical workup for failure to thrive was pursued; however, he was noted to have severe ankyloglossia and was an exclusively breastfed infant. The only interventions during his hospitalization were frenotomy and assistance to the mother to increase her milk supply. The infant immediately experienced weight gain and has continued to show slow, but steady, weight gain as an outpatient. We illustrate here many of the controversies concerning ankyloglossia.
Domperidone is increasingly prescribed to improve breast milk volume despite a lack of evidence regarding its effects on breast milk composition. We examined the effect of domperidone on the nutrient composition of breast milk.
Forty-six mothers who had delivered infants at <31 weeks' gestation, who experienced lactation failure, were randomly assigned to receive domperidone or placebo for 14 days. Protein, energy, fat, carbohydrate, sodium, calcium, and phosphate levels in breast milk were measured on days 0, 4, 7, and 14, serum prolactin levels were measured on days 0, 4, and 14, and total milk volume was recorded daily. Mean within-subject changes in nutrients and milk volumes were examined.
Maternal and infant characteristics, serum prolactin level, and breast milk volume and composition were not significantly different between domperidone and placebo groups on day 0. By day 14, breast milk volumes increased by 267% in the domperidone-treated group and by 18.5% in the placebo group (P = .005). Serum prolactin increased by 97% in the domperidone group and by 17% in the placebo group (P = .07). Mean breast milk protein declined by 9.6% in the domperidone group and increased by 3.6% in the placebo group (P = .16). Changes in energy, fat, carbohydrate, sodium, and phosphate content were also not significantly different between groups. Significant increases were observed in breast milk carbohydrate (2.7% vs -2.7%; P = .05) and calcium (61.8% vs -4.4%; P = .001) in the domperidone versus placebo groups. No significant adverse events were observed among mothers or infants.
Domperidone increases the volume of breast milk of preterm mothers experiencing lactation failure, without substantially altering the nutrient composition.
Milk ejection is essential for a successful lactation, however techniques to measure milk ejection in women are often complex and invasive. Recent research has demonstrated that at milk ejection, milk duct diameter increased in the breast (measured by ultrasound) at the same time as milk flow rate increased (measured using a weigh balance). This study aimed to evaluate a purpose-built continuous weigh balance (Showmilk, Medela AG) to measure changes in milk flow rate from the breast to identify milk ejections during milk expression. In addition, the Showmilk was used to determine if milk ejection occurred simultaneously in both breasts during double pumping.
Increased milk flow rates during single pumping were compared to simultaneous ultrasound measurements of increased milk duct diameters in 14 mothers. In addition, increases in milk flow rate were compared between the left and right breasts of 28 mothers during double pumping for 15 minutes with two separate electric breast pumps attached to two Showmilks to record milk flow rate.
Increased milk flow rates were associated with increased milk duct diameters during single pumping. The mean number of milk ejections was not different between the Showmilk (4.2 +/- 2.0) and ultrasound (4.5 +/- 1.5) techniques. Overall, 67 milk ejections were measured and of these, 48 (72%) were identified by both techniques. The left and right breasts responded synchronously with 95.5% of the flow rate increases corresponding between the breasts. The mean number of milk ejections identified by an increase in milk flow rate during double pumping was 5.1 +/- 1.7 and 5.0 +/- 1.7 for the left and right breasts, respectively. In addition, mothers chose the same expression vacuum for the left (-198 +/- 31 mmHg) and right (193 +/- 33 mmHg) breasts.
The Showmilk can simply and non-invasively record milk ejections by measuring increases in milk flow rate that correspond with increases in milk duct diameter. For the first time measurement of milk flow rate has been used to confirm that milk ejections occur simultaneously in the left and right breasts during double pumping. The use of the Showmilk will facilitate further research into the relationship of milk ejection and milk removal.
Pump-dependent mothers of preterm infants commonly experience insufficient production. We observed additional milk could be expressed following pumping using hand techniques. We explored the effect on production of hand expression of colostrum and hands-on pumping (HOP) of mature milk.
A total of 67 mothers of infants <31 weeks gestation were enrolled and instructed on pumping, hand expression of colostrum and HOP. Expression records for 8 weeks and medical records were used to assess production variables.
Seventy-eight percent of the mothers completed the study. Mean daily volumes (MDV) rose to 820 ml per day by week 8 and 955 ml per day in mothers who hand expressed >5 per day in the first 3 days. Week 2 and/or week 8 MDV related to hand expression (P<0.005), maternal age, gestational age, pumping frequency, duration, longest interval between pumpings and HOP (P<0.003). Mothers taught HOP increased MDV (48%) despite pumping less.
Mothers of preterm infants may avoid insufficient production by combining hand techniques with pumping.
Why do mothers give up breastfeeding, even though breastfeeding has great importance to them? This study examines what has affected mother's confidence in breastfeeding when she gives up breastfeeding.
A metasynthesis of seven studies on mothers' experiences with breastfeeding was conducted using Noblit and Hare's methodological approach.
The metasynthesis shows that confidence in breastfeeding is shaped by shattered expectations and is affected on an immediate level by mothers' expectations, the network and the breastfeeding experts and on a discourse level by the discourses: breastfeeding as nature, the female body as a machine and the note of caution. Foucault's concept of discourse is used to discuss how these discourses affect mothers' confidence in breastfeeding by giving the right to speak about breastfeeding to the breastfeeding experts, by isolating the mothers who do not breastfeed and by organizing knowledge about breastfeeding in a certain way.
The individual mother is responsible for the success of breastfeeding and the discourses are hiding that general perceptions of breastfeeding undermines the mothers' confidence in breastfeeding and leads to shattered expectations.
The purposes of this research were to describe the accuracy of test-weighing with the BabyWeigh, a new infant scale suitable for use in the home, and to determine whether mothers and investigators could estimate intake accurately during breastfeeding sessions, using clinical cues that are recommended for this purpose. Within five days of projected NICU discharge, 30 preterm and/or high risk infants and their mothers were studied during a single breastfeeding session. A member of the research team performed test-weights with the Smart Model 20 infant scale, and mothers performed test-weights with the BabyWeigh scale. The mothers and investigators each estimated volume of intake for the breastfeeding session using clinical cues. Mothers and investigators were blind to each others' test-weights and clinical estimates. Results revealed that the BabyWeigh scale provided an accurate estimate of intake during breastfeeding across a large range of infant weights and intake volumes. In contrast, investigator and maternal estimates of intake were not sufficiently accurate.
To evaluate the effect of early initiation of skin-to-skin (STS) holding on lactation, we compared 24-hour milk volumes of mothers of ventilated low birth weight infants in an STS group to mothers in a non-STS control group.
Mean 24-hour milk volumes at 2, 3, and 4 weeks after delivery of mothers participating in STS holding were compared with those of a retrospective control group from the 12-month period immediately preceding the introduction of STS holding in the neonatal intensive care unit. A repeated-measures analysis of variance adjusting for baseline volumes (1 week after delivery) was used to evaluate the difference in milk volumes between STS and control groups.
Sixteen mothers initiated STS holding during the 2-month study period. Eight mothers met study criteria by initiating STS holding during the first 4 weeks after delivery. During a 2-week period the study group had a strong linear increase in milk volume in contrast to no indicative change of the control group's milk volume.
STS holding of low birth weight infants initiated in the early intensive care phase can result in a significant increase in maternal milk volume, thereby overcoming the frequently seen insufficient lactation experienced by these mothers.
Exclusive breastfeeding was studied among 506 infants in Uppsala, Sweden, based on daily recordings during the first 6 mo. The mothers had previously breastfed at least one infant for at least 4 mo. Most of the mothers considered that they breastfed on demand. Wide variations in breastfeeding frequency and suckling duration were found both between different infants and in the individual infant over time. At 2 wk, the mean frequency of daytime feeds (based on one 13-d record) between different infants ranged from 2.9 to 10.8 and night-time feeds from 1.0 to 5.1. The daytime suckling duration (based on one 24-h record) ranged from 20 min to 4h 35 min and night-time duration from 0 to 2h 8 min. At any given age, a maximum of only 2% of the infants were not breastfed during the night. At 4 mo, 95% of the infants were breastfeeding and 40% were exclusively breastfed at this age. Longer breastfeeding duration and longer duration of exclusive breastfeeding were both associated with higher frequency of breastfeeds, longer breastfeeding of the previous child and higher education. No gender differences were found. Maternal smoking was associated with shorter duration of exclusive breastfeeding, and pacifier use was associated with shorter duration of both exclusive breastfeeding and total breastfeeding. This study confirms that every mother-infant pair needs to be understood as a unique dyad throughout lactation. These data demonstrate a wide range of patterns among women who are exclusively breastfeeding and indicate that it would be inappropriate to put pressure on individual families to adopt preconceived patterns of infant feeding.
This secondary data analysis examined if time of initiation of milk expression and pumping frequency influenced milk weight weeks 2-5 postpartum. Of the 39 subjects in the convenience sample, 20 were in the early initiating (EI) group, (n = 12 high frequency [HF], n = 8 low frequency [LF]), and 19 were in the late intiating (LI) group, (n = 7 HF, n = 12 LF). The EI group initiated pumping < or = 48 hours after birth; the HF group pumped a minimum of 6.25 times daily. A two-way analysis of variance indicated that milk weight was significantly higher in the HF as compared to the LF group. While there was no significant difference in milk weight between the EI and LI groups, there was a significant interaction between frequency and initiation. Milk weight for the LF/EI group appeared to be positively influenced by the initiation of mechanical expression soon after birth.
Galactogogues are medications that aid in initiating and maintaining adequate milk production. Most exert their pharmacologic effects through interactions with dopamine receptors, resulting in increased prolactin levels and thereby augmenting milk supply. Metoclopramide remains the galactogogue of choice due to its documented record of efficacy and safety in women and infants. Domperidone crosses the blood brain barrier and into the breast milk to a lesser extent than metoclopramide, decreasing the risk of toxicity to both mother and infant possibly making it an attractive alternative. Traditional antipsychotics, sulpiride and chlorpromazine, have been evaluated, but adverse events limit their use. Human growth hormone, thyrotrophin-releasing hormone, and oxytocin have also been studied. Finally, a natural product, fenugreek, has been purported to be effective in anecdotal reports. Use of this agent may be warranted after considering risks versus benefits.
To test the effect on milk ejection, an electric breast pump was programmed to provide pumping patterns with frequencies of 45 to 125 cycles/min and vacuums of 45 to -273 mm Hg. The time taken for milk ejection to occur (measured using ultrasound to detect a dilation of a lactiferous duct in the opposite breast) in response to the current Medela electric breast pump pattern (45 cycles/min) was 147 +/- 13 s. For patterns that more closely resemble the sucking frequency of an infant when it first attaches to the breast, milk ejection occurred between 136 +/- 12 and 104 +/- 10 s, although this difference was not statistically significant. Milk ejection in response to breastfeeding occurred after 56 +/- 4 s. The applied vacuum affected the amount of milk that was removed up to 50 to 70 s after milk ejection but not the time for milk ejection.
Although it is well recognized that a thorough understanding of the anatomy of an organ is essential to enable assessment of any abnormalities in that organ, there has been little investigation of the anatomy of the normal lactating breast since Sir Astley Cooper performed detailed dissections of the anatomy of the breast more than 160 years ago. Many mothers recognize that breast milk provides the ultimate nutrition and protection for the infant; however, a significant proportion of women experience difficulties breastfeeding, some of which lead to weaning the infant. Recently, a small number of studies have focused on the gross anatomy of the breast, and have found that the ductal system is comprised of fewer numbers of main ducts than previously thought. In addition, the ducts are compressible and do not contain large amounts of milk, the amount of fatty tissue in the breast is variable, and a proportion is situated within the glandular tissue. These findings add to our understanding of both the physiology and pathology of the lactating breast.
This study aimed to investigate the consistency of milk ejections and milk expression characteristics within mothers at repeated expression sessions.
Twenty-five breastfeeding mothers expressed their breasts simultaneously on three occasions within 3 weeks, and follow-up visits were performed at 6, 9, and 12 months of lactation. During the 15-minute expression, milk was collected onto a continuous weigh balance to measure milk flow rate.
The number of milk ejections was similar at the three sessions (5.1±2.0), decreasing at the 12-month follow-up (3.3±1.2). Mothers had a similar pattern of milk ejection at each session. The time that each milk ejection occurred was consistent for the first 9 months of lactation. Of the four milk ejection patterns identified, each removed a similar percentage of available milk but varied in the time to reach 80% of the total expression volume. The first two milk ejections produced the greatest percentage (62%) of total milk volume during breast expression.
For each individual mother, the timing, pattern, and number of milk ejections were consistent, suggesting a predetermined release of oxytocin. In light of the innate oxytocin release and milk removal characteristics in women, there is potential for individual tailoring of the duration of expression.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. These guidelines are not intended to be all-inclusive, but to provide a basic framework for physician education regarding breastfeeding.
Breastfeeding mothers expressed their breasts hourly for periods up to 7 hours, without exogenous oxytocin, to determine the consistency of milk removal and the relationship between the volume of milk removed and the mother's 24-hour milk production.
Mothers (n = 20) measured their 24-hour milk production from each breast by test-weighing their babies at home. Mothers came to the research laboratory for a day visit and expressed milk from either both or one breast (left or right) for 10-15 minutes, every hour for 2-7 hours. Mothers were not instructed to restrict breastfeeding prior to the first (0-hour) expression.
It was found that the milk volume at 1 hour (59.7 +/- 36.5 and 46.5 +/- 25.6 mL/hour for the right and left breast, respectively) was significantly (p < 0.05) higher than the milk volume from subsequent hourly intervals. The average hourly volumes obtained from the 2nd to 7th hour (18.0 +/- 3.1 and 14.0 +/- 4.8 mL/hour for the right and left breast, respectively) were not significantly different from the average hourly rates calculated for the 24-hour milk production (18.4 +/- 6.3 and 15.5 +/- 5.1 mL/hour for the right and left breast, respectively). Furthermore, local inhibition was not observed during hourly expressions of up to 7 hours.
The average hourly volumes of milk from the 2nd to 7th hour expressions could provide an estimate of the rate of milk secretion. Further study is required to fully validate these findings.
Improving the duration of exclusive breastfeeding is a national and international priority. Insufficient milk supply is one of the most commonly cited reasons for early cessation or decreased exclusivity in women who have initiated breastfeeding. This paper is an integrative review of current research pertaining to perceived insufficient milk (PIM).
CINAHL, MEDLINE, and PubMed were searched combining "human milk" and "milk supply" and "perceived milk supply." Articles were limited to original research studies related to healthy, full-term breastfeeding dyads conducted over the past 10 years. Critical review indicated robust findings, limitations, and gaps in this body of literature.
A lot of women discontinue breastfeeding during the first few weeks of the post-partum period because of PIM and approximately 35% of all women who wean early report PIM as the primary reason. Many women utilize infant satisfaction cues as their main indication of milk supply and many researchers, clinicians, and breast-feeding women do not evaluate actual milk supply. The relationships between PIM and socioeconomic or demographic variables as well as early breastfeeding behaviors have not been adequately addressed in the literature.
Recommendations include improvement of maternal education about behaviors to ensure adequate supply, assessment of milk supply, and infant cues as well as further research into the root causes of PIM.
Practitioners involved with maternal child health can improve their care of women and infants by understanding the subjective nature and questionable accuracy of PIM and changing assessment of milk supply.
Breast milk has been shown to contribute significantly to positive neurodevelopmental and medical outcomes in the extremely low birth weight (ELBW) infant population. It is crucial that ELBW infants receive their mother's colostrum as a first feeding, followed by expressed
breast milk for as long as possible. Evidence-based literature supports the difficult challenges both mothers and ELBW infants face if they are to succeed at breast pumping and breastfeeding. Influencing factors include the medical fragility of the infant, limited frequency and duration of
kangaroo care between mother and infant, lack of an adequate volume of breast milk, as well as inconsistent or incorrect information surrounding the use of breast milk and breastfeeding.A feeding care map as described in this article can help the bedside nurse assist the
mother-ELBW infant dyad in optimizing breast milk volumes, laying the groundwork for breastfeeding. Displaying supportive practices and preterm infant developmental milestones, the map categorizes infant, maternal, and dyad feeding issues along a progressive time line from admission to discharge.
This review aimed to identify interventions to promote breastfeeding or breast milk feeding for infants admitted to the neonatal unit.
The medical electronic databases were searched for papers listed between 1990 and June 2005 which had breastfeeding or breast milk as an outcome and which targeted infants who had been admitted to a neonatal unit, thus including the infant and/or their parents and/or neonatal unit staff. Only papers culturally relevant to the UK were included resulting in studies from the USA, Canada, Europe, Australia and New Zealand. This search was updated in December 2007 to include publications up to this date.
We assessed 86 papers in full, of which 27 ultimately fulfilled the inclusion criteria. The studies employed a range of methods and targeted different aspects of breastfeeding in the neonatal unit. Variations in study type and outcomes meant that there was no clear message of what works best but skin-to-skin contact and additional postnatal support seemed to offer greater advantage for the infant in terms of breastfeeding outcome. Galactogogues for mothers who are unable to meet their infants’ needs may also help to increase milk supply. Evidence of an effect from other practices, such as cup-feeding on breastfeeding was limited; mainly because of a lack of research but also because few studies followed up the population beyond discharge from the unit.
Further research is required to explore the barriers to breastfeeding in this vulnerable population and to identify appropriate interventions to improve breastfeeding outcomes.
To examine the relationship between maternal perceptions of insufficient milk and breastfeeding confidence using the Breastfeeding Self-Efficacy Scale.
Cross-sectional study.
Two hundred and sixty-two in-hospital breastfeeding mothers in Japan.
Breastfeeding self-efficacy was measured in-hospital and perception of insufficient milk was measured at 4 weeks postpartum.
Although most mothers intended to exclusively breastfeed, less than 40% were doing so at 4 weeks postpartum. Among the mothers using formula, 73% cited perceived insufficient milk as the primary reason for supplementation or completely discontinuing breastfeeding. Mothers' perception of insufficient milk at 4 weeks postpartum were significantly related to breastfeeding self-efficacy in hospital in the immediate postpartum period (r=.45, p<.001). Hierarchical multiple regression revealed that breastfeeding self-efficacy explained 21% of the variance in maternal perceptions of insufficient milk, and the contribution was independent of sociodemographic variables.
Enhancing breastfeeding self-efficacy in the immediate postpartum period may reduce maternal perceptions of insufficient milk and the premature discontinuation or supplementation of breastfeeding. Additional research is warranted.
The relation between the frequency of breast-feeding and intake, weight loss, meconium passage, and bilirubin levels was studied in 140 healthy, full-term, breast-fed, Japanese neonates born vaginally without complications. Factors affecting the frequency of breast-feeding were also evaluated. Mothers nursed their neonates, on average, 4.3 +/- 2.5 (SD) times (range 0 to 11) during the first 24 hours after birth, and this frequency increased significantly to 7.4 +/- 3.9 times during the next 24 hours (P less than .001). There was a significant correlation between the frequency of breast-feeding during the first and second 24 hours after birth (r = .69, P less than .001). The frequency of breast-feeding during the first 24 hours correlated significantly with frequency of meconium passage (r = .37, P less than .01), maximum weight loss (r = -.22, P less than .05), breast milk intake on day 3 (r = .50, P less than .01) and day 5 (r = .34, P less than .05), transcutaneous bilirubin readings on day 6 (r = -.18, P less than .05), and weight loss from birth to time of discharge (day 7) (r = -.32, P less than .01). There was a strong dose-response relationship between feeding frequency and a decreased incidence of significant hyperbilirubinemia (transcutaneous bilirubin readings greater than or equal to 23.5) on day 6. The time of birth also affected the frequency of breast-feeding during the first 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
Many women whose premature infants are hospitalized in a newborn intensive care unit choose to express breast milk for their babies. Yet anxiety, fatigue, and emotional stress are powerful inhibitors of lactation. To facilitate the breast-feeding experience, intervention mothers were given a 20-minute audio cassette tape based on relaxation and visual imagery techniques. At a single follow-up expression of milk at the hospital approximately 1 week after enrollment, they expressed 63% more breast milk than a randomized group of control mothers. The fat content of the breast milk in the two groups was not significantly different. Among a small group of mothers whose infants were receiving mechanical ventilation, the increase in milk volume compared with that of control mothers was 121%. Longer-term effects of the relaxation/imagery approach (such as extending the duration of breast-feeding or reducing parental stress after hospital discharge) and the physiologic basis for the increased volume of expressed milk (improved milk production v more efficient milk ejection) are appropriate topics for future research.
In an experimental study to determine whether augmentation of maternal milk supply affects infant intake, 18 mothers of exclusively breast-fed infants stimulated milk supply by daily expression of extra milk for 2 weeks. Infant milk intake was recorded before, during and after this expression phase. All but 4 mothers increased milk production by greater than 73 g/day over baseline, with an average increase of 124 g/day. On the average, the 14 infants of mothers who increased milk production took in significantly more milk immediately following the expression phase (849 vs. 732 g/day), but about half of them returned to near baseline levels of milk intake after 1-2 weeks. Net change in infant intake at the end of the study was positively correlated with infant weight-for-length (r = 0.59) and age (r = 0.58), and was unrelated to baseline milk intake (r = -0.06). Therefore, the wide range in breast milk volume in well-nourished populations is due more to variation in infant "demand" than to inadequacy of milk production.
Infant test weighing and maternal test weighing are two independent methods for determining milk intake by the breast-fed infant. The sources of error in both these test weighing methods were examined with particular emphasis on the importance of evaluating and correcting for evaporative water loss (EWL). EWL ranged from 3 to 94% of the mother's change in weight after a single breast feed and from 3 to 55% of the infant's change in weight after a single breast feed. Correcting for EWL during a breast feed involved determining the time between the pre- and postfed weighings and measuring the rate of EWL after breast feeding. Significant correlations (p less than 0.001) were found between milk volume intake measured by test weighing the mother and correcting for maternal EWL, and milk volume intake measured by test weighing the infant and correcting for infant EWL. An improved method for measuring 24-h milk intakes by maternal test weighing using a sensitive electronic balance and correcting for EWL is described. The milk intakes, corrected for EWL, ranged from 690-1,041 g/24 h. If no correction for EWL was made then the average overestimate of milk intake by maternal test weighing was 14 +/- 6%.