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.
Abstract: McGuire, Elizabeth The non-gestational mother in a same-sex relationship induced lactation so as to breastfeed her child. Using domperidone and frequent breast expression, she successfully established milk production adequate to exclusively breastfeed her child and took on the role of primary breastfeeder. The two women found challenges in negotiating shared breastfeeding and in the exhaustion attendant on feeding and expressing day and night while both maintained full breastmilk production.
This case illustrates the importance of expressing to establish and maintain a full induced milk supply, and the flexibility that lesbian couples may use in managing their reproductive lives. Both mothers in this relationship experienced breastfeeding as an important aspect of mothering, though it was not easy to co-parent in this way.
Abstract: Khan, Abul Salim; Shahid, Mohd Despite a proven inverse relationship between breastfeeding within one hour of birth and neonatal mortality, breastfeeding in India is marked by delayed initiation and a limited period of exclusive breastfeeding. This appears to be 'popular common sense', but it is not good sense, as it normalises the delayed initiation of breastfeeding. Narratives in the form of popular common sense perceptions around breastfeeding practices, were collected from Muslim women living in three different urban centres and regions of India - Haldwani, Nainital, Uttarakhand (north); Aligarh, Uttar Pradesh (centre) and Hyderabad, Telangana (south). 'Popular common sense' is used as a theoretical lens to understand how breastfeeding rituals are sanctified as normal and natural in popular perceptions. The diversity, intricacies, and cultural embeddedness of breastfeeding practices are explored and elaborated. It is argued that for promoting early and exclusive breastfeeding, it is important that public health professionals understand and negotiate 'popular common sense' perceptions on breastfeeding practices.
Abstract: Issa, Carine; Hobeika, Maria; Salameh, Pascale; Zeidan, Rouba Karen; Mattar, Lama This study aims to investigate the positive association between a longer duration of breastfeeding and better health outcomes from birth to 36 months by using direct health outcomes and indirect health indicators. It is a cross-sectional study including 222 toddlers aged 12-48 months. Questionnaires were completed in 2015 by mothers who had attended at least one breastfeeding counselling seminar in Lebanon. Breastfeeding duration, sociodemographic variables and health indicators were collected and analysed. Results showed that the majority of infants (65.8%) did not receive formula milk right after birth and 28.4% never had formula milk. Thirty-two per cent were exclusively breastfed for 6 months and total breastfeeding duration exceeded 6 months for 74.8% of the sample. Longer durations of both exclusive and total breastfeeding were significantly associated with fewer paediatrician visits, fewer antibiotic prescriptions, a lower occurrence of colic, urinary tract infections and decreased odds of being overweight from birth to 36 months. A longer duration of exclusive breastfeeding was associated with a lower occurrence of rhinitis and decreased odds of suffering from asthma, wheezing and reflux. A longer duration of total breastfeeding was associated with a lower occurrence of diarrhoea and vomiting. Our results would encourage mothers to prolong breastfeeding duration given its positive implications on toddlers' health.
Abstract: Phoebe, Raychelle; Fetherston, Catherine M; Nilson, Caroline Background: A range of supports are required to protect and promote breastfeeding and although Australia boasts high initiation rates, these supports have not yet been able to increase duration of breastfeeding to achieve national and global targets.
Aim: To explore the current literature describing the range of formalised supports being implemented to assist Australian breastfeeding mothers and better enable understanding of where the future focus is required to improve support and ensure breastfeeding success.
Method: A search for relevant peer-reviewed and grey literature published after 1989 was undertaken using CINAHL, PubMed, Cochrane Library, Proquest, Scopus and Google Scholar.
Findings: Breastfeeding support in Australia exists as globally influenced, policies and directives that inform a range of recommended management procedures, clinical practice and community support. Despite this broad approach, unsupportive societal attitudes still exist and breastfeeding prevalence remains suboptimal. There is also uncertainty regarding how support, from an individual to community health level, is implemented effectively for improved sustainability.
Conclusion: Strengthened support at all levels is needed to see the cultural change needed for improvement. Further research into how women interact with support may prove valuable in revealing ways in which current breastfeeding supports can be strengthened to avoid early cessation.
Abstract: Page, Tracy A; Lai, Jessica; Zheng, Linda; Webster, Kate L; Gill, Anna C Background: Neonatal frenotomy is thought to be associated with improved breastfeeding and benefits for mothers and babies. We examined the outcomes, parent perceptions and documentation of the procedure in a group of parent/infant pairs surveyed post-frenotomy.
Methods: Parents completed a qualitative survey focusing on reasons for frenotomy, perception of the procedure and breastfeeding outcomes. Medical records were also reviewed.
Results: Frenotomy was performed in 42 of 3608 (1.2%) of newborns over 3 years. Thirty (71.4%) of the parents completed surveys and 24 (80%) of these parents felt that the procedure improved breastfeeding. Most parents felt well informed about the procedure. Minor bleeding was the only complication noted. Duration of breastfeeding was >8 months with no difference between procedures performed early (= day 8 of age). Documentation of indication, severity, procedure and observation of feeding was excellent. Written documentation of parent discussion and verbal consent was absent in 47% of cases.
Conclusions: Frenotomy is quick, safe and effective in carefully selected patients. Comprehensive lactation and paediatric assessments are important to address other difficulties that can contribute to the breastfeeding interaction. Documentation of parent consent could be improved in our setting. The study provides guidance for development of a local management pathway.
Abstract: Stevenson, Laura E The purpose of this health promotion project was to increase the number of businesses promoting and supporting breastfeeding in South-West Victoria. As a strategy to support the Municipal Health and Wellbeing Plans of the Corangamite and Moyne Shires, under the South-West Primary Care Partnership (SWPCP) Integrated Health Promotion Plan, local health services, Corangamite Shire early years and SWPCP health promotion staff, undertook audits of venues using the Australian Breastfeeding Association's (ABA) Breastfeeding Welcome Here program. One hundred and six venues were audited across 33 rural communities. As part of the evaluation, 23 local mothers completed a qualitative survey via social media. In the survey, 65.2% of respondents stated they had seen the ABA's Breastfeeding Welcome Here stickers in their local community. In addition, 82.61% of respondents stated they would feel more comfortable to breastfeed in a 'Breastfeeding Welcome Here' accredited site. The evaluation also explored possible considerations for ABA to further improve the Breastfeeding Welcome Here program. Embarrassment when breastfeeding in public is a major barrier to increasing breastfeeding rates internationally. Based on the findings of this project, programs such as the ABA's Breastfeeding Welcome Here program can help in addressing this barrier. However, further work needs to be done to improve community acceptability.
Abstract: McGuire, Elizabeth In 2004, in response to evidence of a re-emergence of iodine deficiency in Australia, a National Iodine Nutrition Survey was conducted. The survey found that while Western Australia and Queensland were iodine sufficient, South Australia was borderline deficient and New South Wales, Victoria, and Tasmania were mildly iodine deficient. In New Zealand, the 2002 National Children's Nutrition Survey had found that the New Zealand population also lived with mild iodine deficiency. Australia and New Zealand mandated iodine fortification of bread in 2009 because the prevalence and gravity of iodine deficiency in both countries was considered to require intervention and mandatory fortification of a staple food was regarded as the best strategy. During 2010, the National Health and Medical Research Council (NHMRC) recommended supplementation for pregnant and breastfeeding women and women planning a pregnancy because the iodine content of bread was not designed to meet their increased needs.
Abstract: Connolly, Emma L; Reinkowsky, Misty; Giglia, Roslyn; Sexton, Belinda; Lyons-Wall, Philippa; Lo, Johnny; O'Sullivan, Therese A The Baby Friendly Health Initiative (BFHI) aims to improve breastfeeding initiation and continuation. Teaching antenatal colostrum expression (ACE) may also promote positive breastfeeding outcomes. However, there is concern that this may impact birth outcomes.
This study was a retrospective audit of medical records from 294 women attending a general public hospital in Western Australia. The aim was to assess breastfeeding and birth outcomes before and after provision of ACE education and BFHI care as standard hospital practice. Breastfeeding, infant and obstetric outcomes were assessed across three time periods representing different situations: no routine ACE education or BFHI accreditation (n = 98); ACE education only (n = 100); and both ACE education and BFHI accreditation (n = 96).
Results showed that mothers were more likely to see a lactation consultant after introduction of ACE education (p = 0.045) and with BFHI care (p = 0.053); and increased initiation of breastfeeding as the first feed was also observed (p = 0.049). ACE education was not associated with significantly increased rates of special care nursery admission, or lower gestational age at birth. No significant differences in infant formula use were detected.
Further research is warranted to investigate the impact of antenatal education on rates of ACE performance, and explore both antenatal expressing and the BFHI care in relation to longer-term outcomes, including exclusive breastfeeding duration.
Abstract: McGuire, Elizabeth Bariatric surgery is increasingly common among women of reproductive age. Dramatic weight loss following successful bariatric surgery and improvement in metabolic health may allow some women to conceive, but pregnancy after bariatric surgery comes with the risk of nutrient deficiencies that can have serious and long-term implications for the health of the offspring. The medical literature includes some recommendations for managing pregnancy post-bariatric surgery, but there is little mention of breastfeeding or particular problems faced by a breastfeeding dyad after bariatric surgery.
Abstract: Pramono, Andini The rate of exclusive breastfeeding in Indonesia did not meet the national target which was set at 80% in 2014 but reduced to 50% in 2019. Based on Basic Health Research (2013), only 38% of babies aged 0-5 months were exclusively breastfed. The Indonesian Ministry of Health (Indonesian Health Profile, 2016) reported that only 55.7% of babies were exclusively breastfed. Though it seems that the national target rate was reached, in fact some provinces had low exclusive breastfeeding rates. Indonesia has published regulations for breastfeeding such as 'Government Regulation Number 33 Year 2012 on Exclusive Breastfeeding'. The objective of this research was to analyse breastfeeding policy and its implementation in Indonesia. The research methodology was a literature review on Indonesian regulation. The review demonstrates that policy implementation still needs to be monitored and evaluated. Recommendations are made for the medical professional association and the government.
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