Abstract: Hull, Naomi; Kam, Renee L; Gribble, Karleen D Concerns of mothers seeking breastfeeding support during the COVID-19 pandemic and the experiences of Australian Breastfeeding Association (ABA) volunteers who assisted them were explored via an online survey. Surveys were completed 16 March to 18 May 2020 and described the COVID-19 related concerns of 339 individuals. One hundred and thirty-six mothers (64%) sought support to protect their infants by continuing breastfeeding, increasing milk supply, or restarting breastfeeding. Mothers were commonly stressed, isolated and needing reassurance. Thirty-four (10%) raised concerns about COVID-19 and breastfeeding safety. One hundred and twenty-nine (61%) informed survey respondents (ABA volunteers) they were unable to access face-to-face health services because of fear or unavailability. Most common breastfeeding concerns were related to insufficient milk or weight gain, painful breasts, relactation and reducing supplemental milk. Respondents reported mothers were worried that stress had reduced milk supply, that milk supply concerns were exacerbated by the inability to weigh infants and that seeking medical treatment was delayed. Respondents stated they felt supported and confident assisting mothers while also expressing distress at mothers' situations. ABA's role in emergency response should be recognised and national planning for infant and young child feeding in emergencies must be urgently developed, funded and implemented.
Abstract: Smith, Julie P; Iellamo, Alessandro During emergencies and disasters infant survival can depend on their access to breastfeeding or human milk. Wet nursing and donor human milk sharing are options endorsed by the World Health Assembly (WHA). This study looks at regulatory environments for wet nursing and donor human milk sharing and considers the wider food security and resilience implications.
Legislation and policies relating to wet nursing, donor human milk sharing and milk banking can support appropriate infant and young child feeding in emergencies responses (IYCF-E). However, in many countries there is a lack of legislative and regulatory clarity on protecting and supporting breastfeeding practices in these situations. This is true for all income country settings and geographic regions.
High breastfeeding prevalence in a country can reduce exposure to food insecurity and risk for mothers and their children during emergencies. Regulatory clarity is also needed to protect safe wet nursing and donor human milk sharing, being an important step in developing protocols and plans for emergency preparedness and response. With human milk products becoming more available, there is also an urgent need to ensure full implementation of the IYCF-E Operational Guidance and the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes and subsequent relevant WHA Resolutions.
Abstract: McGuire, Elizabeth This paper reports a woman's experience of repeated episodes of mastitis in the context of early nipple trauma and an abundant milk supply. She was treated with prophylactic antibiotics that appear to have controlled further outbreaks until her milk production aligned with her infant's appetite.
Abstract: McGuire, Julianne; Irvine, Susan; Smith, Julie; Gallegos, Danielle Responsive infant and young child feeding (IYCF) in formal early childhood education and care (ECEC) is integral to optimal child development and health outcomes. This research explored supportive environments for and educator perspectives on implementing responsive feeding in Australian ECEC settings.
Data was collected from 19 Queensland long day care and family day care services through professional conversations with 124 educators, semi-structured interviews with service leaders and environmental audits using NAP SAAC survey tool and images. Services covered metropolitan, regional, high and low socioeconomic areas. The Framework method enabled inductive thematic and deductive analysis using Bronfenbrenner's ecological model.
Qualitative analysis identified themes 1) educator knowledge, efficacy and agency, 2) environment and 3) monitoring/surveillance as key factors affecting collective system support of responsive feeding and infant agency. The study highlights the importance of enabling leadership within services, educator knowledge of IYCF and efficacy working with perceived system barriers to provide optimal ECEC environments for responsive IYCF.
Results elucidate the need for policy leadership to ensure IYCF visibility in national policies and guidance and adequate pre-service and on-the-job-training on responsive feeding. Achieving best practice in IYCF also requires strengthening educator self-efficacy working with parents in supporting responsive feeding for developing infant agency.
Abstract: Yao, Ting; Blackburn, Karen; Frutchey, Cheryl; Burton, Denise Breastfeeding has numerous benefits for infants and mothers. The Chinese government attaches great importance to breastfeeding and takes measures to increase the exclusive breastfeeding rate and breastfeeding duration among women. As in many nations, health care professionals are a major contributor to the support of breastfeeding. However, lactation consultation by Chinese health care professionals is hindered by several barriers including limited lactation professionals, limited breastfeeding knowledge among health care professionals, understaffed maternal and infant units, impacts of economic factors and health care policies. Currently, health care professionals proficient in lactation and a group of special individuals called 'Cuirushi' are primary providers of lactation consultation. The purpose of this paper is to describe the overall status of breastfeeding in China, illustrate challenges for Chinese health facilities and professionals in support of breastfeeding and lactation consultation, introduce lactation consultation resources available to mothers and infants, and analyse positive and negative aspects of the Cuirushi. Strategies concerning the regulation of Cuirushi and optimisation of the current lactation consultation resources are presented to support breastfeeding and protect the health of mothers and infants.
Abstract: Campbell, Vanessa A This research explored what a charity can do through their Facebook communication, to build stronger online relationships that, in turn, motivate followers to develop real-world relationships (ie group meeting attendance, volunteering, training, or charitable giving) (Bridges, personal communication, May 16, 2017).
Online focus groups and interviews explored the ways that the Australian Breastfeeding Association (ABA) can enhance their online relationships to develop real-world interactions that aid the sustainability of the organisation (Rosenberg and Yates, 2007).
Schoenmaker's (2014) framework of conversing, sharing, connecting, engaging and relating was used to conceptualise a progression of different levels of relating, from online connection to physical-world relationship. Bridges' (2016) categorisation of the engagement-increasing factors of support, community, complementary services and immediacy, to understand how to foster relating via Facebook communication, were also used.
The research found that Facebook followers who share their experiences, respond to others and engage in dialogue are more likely to feel invested in their Facebook community, and more willing to explore relating to ABA in real life. These sharing and dialogic outcomes are more likely to occur in closed Facebook groups than open, public pages and sites.
Abstract: Buck, Miranda; Amir, Lisa H; McDonald, Karalyn Background: Although most Australian mothers initiate breastfeeding and some continue to breastfeed through exceptional difficulties, 50% stop breastfeeding before they had originally planned to. While studies have explored women's experiences of breastfeeding, there is a gap in our knowledge of how breastfeeding problems relate to the experience of becoming a mother.
Method: We report a phenomenographical analysis of an online forum discussion with 25 Australian new mothers, who had previously been participants in a quantitative study (the CASTLE study) about early breastfeeding experiences.
Key findings: Three themes were identified: 'unpreparedness, out of control and on your own'. Within these themes were experiences that included bodily transformation, vulnerability and burden. The women constructed these experiences as problems that they needed to resolve, and they tackled them practically, cognitively and emotionally. In describing their physical transformation and the challenges of initiating breastfeeding, the women's stories mapped their pathways into motherhood.
Conclusion: The women described unsettling journeys, which were only understandable from the other side of the experience, and ultimately transformative. The experience of participation in the CASTLE study during the early postpartum period was described as reassuring and supportive, not only of breastfeeding but also of mental wellbeing, during a time of isolation and transformation.
Abstract: Ahmadzai, Hila; Crowe, Andrew; Tee, Lisa BG Despite the known risks associated with opioid use during breastfeeding, their place in therapy is established as part of a multimodal approach to treatment of pain in the early postpartum period. Opioids may be prescribed for post-caesarean analgesia without adequate patient education, resulting in adverse drug events in breastfed infants. We report the case of an exclusively breastfed 6-day-old infant who presented with symptoms of progressive drowsiness, somnolence and inability to feed. Maternal medication use was discounted as a potential causative factor and it was not explored further, despite the mother taking a long-acting opioid at the time. A series of invasive investigative tests were carried out and the infant was commenced on intravenous antibiotics for suspected sepsis. All test results were negative for infections and no causes for the symptoms. The infant was discharged 3 days later with a formal diagnosis of a 'probable viral infection'. A lack of understanding by healthcare professionals of the impact of maternal medication use (particularly drugs with known risks) on breastfed infants can result in infant ADE, inappropriate prescribing, stress and anxiety for new parents and a lost opportunity to contribute to lactation-related medicines information.
Abstract: Baker, Phillip Breastfeeding, breastmilk substitutes and first food systems
Breastmilk is a personalised source of early-life nutrition, providing optimal nutrients in volumes regulated by the mother-child feeding dyad and biological factors that are crucial for the development of the child (Victora et al., 2016). To achieve optimal growth, development and health the World Health Organization (WHO) recommends infants are exclusively breastfed for the first 6 months of life and thereafter receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond (World Health Organization [WHO], 2003). The WHO/UNICEF Global strategy for infant and young child feeding (GSIYCF) calls on governments to implement actions to support, promote and protect breastfeeding, including adoption of The International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions (The International Code) into national legislation.
Abstract: Cole, Roni; Young, Jeanine; Kearney, Lauren; Thompson, John MD ABSTRACT Reducing sleep-related infant mortality is a national and global health priority. The leading category of postneonatal mortality in Australia is sudden unexpected death in infancy (SUDI). Suboptimal breastfeeding practice is associated with increased risk of infants dying suddenly and unexpectedly. Human breastmilk is universally acknowledged to be the optimal form of nutrition, contributing to child survival and conferring immunologic advantage over formula-feeding. This paper presents an analysis of data from the 2017 Infant Caregiver Awareness and Routines Evaluation among Queenslanders (I-CARE Qld) Study to establish the maternal and infant characteristics, infant care practices and sleep-related factors that influence breastfeeding duration within a contemporary Australian cohort. A cross-sectional survey of 3341 Queensland caregivers with infants approximately 3 months old was conducted. Statistically significant predictors for breastfeeding cessation at 8 weeks were found using univariable and multivariable analyses. These include: young maternal age, single, less educated, smoker, public patient, higher pre-pregnancy body mass index (BMI), the birth of a male infant, delivery via caesarean section, in-hospital formula supplementation, admission to a neonatal nursery, dummy use and infant sleep location. Given the increased risk of sudden infant death related to suboptimal breastfeeding practices, further consideration and strategies targeting these potentially at-risk population groups are required.
Abstract: Stacey, Alison J Dysphoric milk ejection reflex is experienced as intense negative emotions temporally related to the ejection of milk during lactation. A recently published study provides further characterisation of this phenomenon. The current research, its limitations, and possible areas for further research are discussed in this commentary.
Abstract: Fludder, Christian J; Bourgeois, Jenelle There are many reasons for the cessation of exclusive breastfeeding prior to the recommended age of 6 months, one being breastfeeding difficulty. This case study chronicles one case of a 4-week-old presenting to a chiropractic clinic with breastfeeding difficulty, failure to thrive, and restrictions observed in cervical spine passive range of motion. A trial of spinal manipulative therapy was commenced. A maternally reported improvement in breastfeeding, an increase in passive range of motion, and an increase in weight were observed during this trial of care. Future prospective trials incorporating chiropractic management as a part of collaborative care in infants with breastfeeding difficulty and restrictions in cervical spine range of motion may be of benefit.
Abstract: Russell, Judith; King, Rosemary Hyperlactation refers to excessive breastmilk production over and above the infant's needs. It may cause a range of distressing and uncomfortable symptoms for mother and infant, potentially affecting breastfeeding duration. The majority of cases will resolve through common, supportive management strategies that aim to reduce breastmilk supply through the negative feedback mechanism of milk production. Some herbal and pharmaceutical agents are considered to reduce breastmilk production and may be used to manage hyperlactation. One of these medications, pseudoephedrine, has been reported anecdotally to reduce breastmilk production, but there is a lack of evidence to support its use in this context. This case report details the use of pseudoephedrine as a 'last resort' treatment for a mother experiencing hyperlactation which had not responded to the usual management strategies. By titrating the dose according to her milk production, the mother was able to effectively self-manage hyperlactation and maintain an adequate breastmilk supply without any apparent adverse effects to herself or her baby. This suggests that pseudoephedrine has potential for use in the management of severe hyperlactation. However, pseudoephedrine should be used with caution and in conjunction with professional lactation support and supervision.
Abstract: Bearzatto, Anita Slow weight gain in the breastfed infant is a common issue facing community health nurses, general practitioners (GPs), paediatricians and lactation consultants. The cause is usually multifactorial but in most cases is associated with inadequate caloric intake. Slow weight gain may negatively impact on the infant's future health and is a common cause of parental anxiety and early breastfeeding cessation.
Abstract: Pramono, Andini; Desborough, Jane; Smith, Julie In 2018, the World Health Organization (WHO) issued the first revision of the 1989 WHO/UNICEF Ten Steps to Successful Breastfeeding. While there is evidence of the effectiveness of those Ten Steps in increasing breastfeeding rates, there has been no published analysis of the key differences between the two versions. We aim to summarise the key changes in each of the Ten Steps and explore the benefits and cost implications.
We first review the background to recent changes and then compare the evolution of each of the Ten Steps since 1989. Thirdly, we explore the implications of new implementation guidelines in terms of the cost and benefits from different perspectives.
Revisions are subtle, yet meaningful for implementation. A major change made by WHO is subdividing the Ten Steps into 1) critical management procedures, and 2) key clinical practices. Lessons have been learned on how the change has shifted the focus from health care staff to parents and families and shifted the responsibility for some elements of care from hospitals to the community. Exploring the costs and benefits of the Ten Steps, and who has responsibility for implementation, may increase understanding of how the Baby-Friendly Hospital Initiative (BFHI) can be implemented to make it more universal, cost-effective and sustainable. Commitment is needed from policy-makers to integrate the BFHI into health systems and health financing. Future research will examine this at the country level.
Abstract: Amir, Lisa H; Donath, Susan M; Cullinane, Meabh; Buck, Miranda L Maternal infant-feeding intention is a strong determinant of breastfeeding initiation and duration. However, the effect of intended breastfeeding duration on infant-feeding practices has been less studied. This secondary analysis uses data collected in the CASTLE study which investigated the roles of Candida and Staphylococcus aureus in nipple and breast pain in breastfeeding women; 360 women intending to breastfeed for at least 8 weeks were recruited in late pregnancy and followed weekly for first 4 weeks postpartum. Intended breastfeeding duration was ascertained at recruitment. Method of infant feeding in previous 24 hours was collected at each time point. Women who intended to breastfeed for 6 months, RR 1.5 (95%CI 1.1, 2.1, p=0.01). Only 38% (129/336) of women were completely breastfeeding at the breast at all time points in first 4 weeks; women intending to breastfeed for > 6 months were more likely to be completely breastfeeding at the breast at all time points: 41% (89/220) compared to 26% (30/116) (RR 1.6, 95%CI 1.1, 2.2, p=0.008). This suggests that some early formula use stems from maternal perception rather than infant requirement. Clinicians could ask all women antenatally how long they plan to breastfeed to facilitate a discussion about global recommendations for 6 months' exclusive breastfeeding and continued breastfeeding for two years and beyond.
Abstract: Eden, Kathryn; Carroll, Katherine; Williamson, Rebecca; Butler, Andrea; Smith, Julie Our study focuses on designated breastfeeding rooms on campus at a leading Australian university. Universities have a growing female staff and student cohort, including breastfeeding women who are legally protected to breastfeed. As part of a wider university initiative to improve gender equity and family friendliness, our study used a walk-through audit to evaluate 11 designated private breastfeeding rooms on campus. The rooms were benchmarked against criteria derived from the Australian Breastfeeding Association's Baby Care Room award checklist. Eight of the 11 designated breastfeeding rooms were purpose-built with excellent facilities, but the majority were difficult to locate and access. Our analysis found that clarifying access requirements and improving signage to designated breastfeeding rooms would signal the inclusion and valuing of the lactating body on campus. This, in turn, would contribute to a more welcoming organisational culture for breastfeeding women visiting, working or studying on campus. We situate our results within broader feminist perspectives on how 'leaky' embodied practices of reproductive labour challenge prevailing workplace norms about productivity. Our findings may apply to other publicly-engaged and outwardly-facing organisations who provide services or employment and wish to improve their lactation rooms.
Abstract: Kundisova, Lucia; Bocci, Gloria; Golfera, Marco; Alaimo, Lucia; Nante, Nicola Background: Breastmilk's nutritional properties have been known to humanity for centuries. Human milk banks are institutions providing donor human milk to babies with limited access to breastfeeding, especially preterm babies.
Research aim: The aim of this study was to undertake a systematic review of literature, regarding the characteristics and motivations of milk donors and to identify factors influencing their willingness to donate their breastmilk.
Methods: The systematic review of literature was conducted using PRISMA statement. Papers were searched in PubMed database using the terms: 'Milk bank AND donor characteristics'. After screening, seven papers were included. Two reviewers read the papers and produced an overview table.
Results: The majority of studies (three) were undertaken in Brazil, one in USA, and three in Western Europe (Italy, Spain and France). Differences in donors' characteristics were observed across the studies. Average age of donors varied; the youngest donors were reported in Brazil (24.8 +- 5.2 years), the oldest donors were reported in Italy (35-36 years old). The majority of donors were married. The percentage of donors with medium-high education level was higher in USA and European countries (83%-87%) in comparison to Brazil (39%-78%). Donors in Brazil were less likely to be employed outside the home (53%-63%); on the other hand, only 35% of North Americans stayed at home. Work situation of donors did not influence their willingness to donate milk. In almost all studies, primiparous donors represented around 50%. Average donation period was 3-4 months; the age of donors was inversely associated with volume of donated milk. The most important source of information about breastmilk donation was healthcare professionals. The most frequently reported motivations to donate reported in the studies were 'desire to help other babies' and 'excessive milk production'. Recommendation from healthcare professionals and knowledge of infant needs were important motivations among Brazilian donors. The majority of donors evaluated their experience as 'positive' or 'excellent'.
Conclusion: To ensure an adequate quantity of breastmilk for Human Milk Banks (HMB) it is necessary to enrol new milk donors continually. In this process the role of educated and dedicated healthcare professionals is absolutely fundamental.
Abstract: McGuire, Elizabeth Among women who do not produce enough milk to exclusively breastfeed their infants, some appear to have their milk production limited by their volume of mammary glandular tissue. Sparse breast glandular tissue leading to low milk production has been associated with polycystic ovary syndrome, exposure to endocrine-disrupting pollutants and so-called tuberous breasts. This paper reports a case of insufficient glandular tissue without those recognised risk factors. There are many potential points of disruption in breast development that may result in underdeveloped breasts or breast hypoplasia. Small breasts do not necessarily indicate lack of milk production, so the term 'insufficient glandular tissue' indicates lactational shortfall in combination with sparse glandular tissue. 'Insufficient glandular tissue' may be compatible with partial breastfeeding, but the term 'insufficient' refers to the mother's inability to provide all the milk her infant needs from her breast. Regardless of the mechanism, the mother's experience of being unable to provide enough breastmilk in spite of following established advice is frustrating and distressing.
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