Abstract
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A significant body of research has looked at the issues of lactation failure. Outcomes include failure of the mother to reach her intended breastfeeding goals as well as complete lactation failure. Studies have reported the views of physicians, International Board Certified Lactation Consultants (IBCLCs), and miscellaneous health workers. The report in this issue of the journal, “Women's Perceptions of Breastfeeding Barriers in Early Postpartum Period: A Qualitative Analysis Nested in Two Randomized Controlled Trials,” 1 tried a new approach. Ask the mother what she thinks! The investigators did exit interviews on a 20% random sample of participants who had been enrolled in two randomized controlled, single-blind promotion trials of breastfeeding. These trials were originally structured to measure the effectiveness of routine primary care-based pre- and postnatal interventions to increase breastfeeding among their low-income minority clients. The clients were randomized into one of three intervention protocols or a control group. The exit interview items were structured to evaluate the study protocol and perceptions of the effects of the interventions as perceived by the mothers themselves. The interviews were recorded, transcribed, and coded by independent coders using modified grounded theory methodology. Breastfeeding intensity was rated, at 1 month, as high, medium, or low. Eighty-eight percent of infants received some formula in spite of the philosophy of the unit and the availability of IBCLCs. The mothers identified barriers to breastfeeding as the lactation process, latch problems, medical issues, and medical staff and hospital routines. Most important is that the mothers identified the first few days in the hospital as being the biggest challenge to avoiding formula.
Mothers' perceptions that they did not have enough milk was critical. The value of an IBCLC explaining normal milk supply in the first few days was most important in avoiding formula. In each scenario, the mothers felt that it was the IBCLC who came to the rescue and found a solution to the problem. The authors concluded that the IBCLCs provided accurate information, strengthening the benefit and feasibility of breastfeeding, and, second, that they provided the support and encouragement in the actual performance of breastfeeding.
As hospitals look at their resources and priorities in order to meet the Joint Commission mandates to provide breastfeeding support postpartum, the extreme importance of the first few days and the consistent availability of IBCLCs is once more confirmed.
This issue of the journal also sheds some light on the pervasive issue of chronic breast pain, which frequently results in the termination of breastfeeding. Pain has resulted in a huge increase in the use of antifungals on the presumption that the pain is the result of a yeast infection. More recently, the assumption has been if the pain is not due to a fungal infection, it must be bacterial, particularly Staphylococcus aureus and coagulase-negative Staphylococcus. Until now quantification of cultures has not been available to settle the debate. Witt et al. 2 report “A Case Control Study of Bacterial Species and Colony Count in Milk of Breastfeeding Women with Chronic Pain” in this issue of the journal. The authors meticulously cultured mothers who had come to their clinic with unresolved breast pain lasting more than a week. Matched controls were also recruited. Milk was collected from all the women, and follow-up e-mail questions were collected biweekly for 12 weeks. Breastmilk S. aureus was statistically associated with a history of plugged ducts, but no other problems. The discussion provides a detailed interpretation of the culture results. The authors conclude that S. aureus may be pathogenic in cases of chronic breast pain. Coagulase-negative Staphylococcus was not found to be associated with chronic pain.
Cultures can be helpful in the evaluation of chronic pain to avoid excessive use of ineffective treatments while identifying appropriate and necessary antimicrobial treatment. These data provide important information for more focused therapeutic analysis of chronic pain by the physician.
It is with great pride and pleasure that we publish the newest update of “Protocol #2: Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother: ‘Going Home Protocol,’” authored by Evans et al., 3 reviewed by the Protocol Committee, and approved by the Board of Directors of the Academy of Breastfeeding Medicine.
The editors also acknowledge the valuable work of our reviewers in 2013 with a rousing round of applause. Thank you.