Journal of Human Lactation

The Healthy People 2010objective to increase US national breastfeeding rates uses data from the Ross Laboratories Mothers Survey for monitoring. Because of scientific and political problems related to the use of these data, the Centers for Disease Control and Prevention (CDC) recently held a meeting on surveillance systems for monitoring breastfeeding behaviors in the United States. Participants identified and discussed 12 surveillance systems that collect or could collect breastfeeding data. None of the existing systems met the participants' definition of an ideal system, although each was seen as providing additional insight into breastfeeding behaviors. Key recommendations are to (1) justify the need for additional resources to build a comprehensive national system; (2) add questions on breastfeeding incidence, duration, and exclusivity to the National Immunization Survey; (3) ensure that breastfeeding questions on national surveys are consistent; and (4) encourage state use of the breastfeeding module of the CDC's Pregnancy Risk Assessment Monitoring System.

The aim of this prospective study was to compare serum C-reactive protein (CRP) and leukocytes, hemoglobin, clinical signs, treatment, and outcome among 41 episodes of lactation mastitis grouped by the outcome of bacterial cultivation of breast milk. Group A included 25 cases with positive cultures only for bacteria normally present on skin. Group B included 16 cases in which cultures indicated the presence of potentially pathogenic bacteria. Serious complications were observed among women in group B, including protracted illness and weaning. No complications were observed in group A. Staphylococcus aureuswas the most frequently isolated bacteria in group B. Mean serum leukocytes were significantly higher in groupBthan in group A. AlthoughCRPlevels in both groups were elevated, no significant difference was found between groups. Rest and frequent emptying of the breast were curative in group A. Further interventions were necessary for mothers in group B.

Atrialwas conducted with 51women randomly assigned either to a conventional nursing care group or to an individualized professional support group; to examine the effect of professional support on breastfeeding status at 4 weeks postpartum. All participants identified themselves as having no prior support. At 4 weeks postpartum, 17 out of 25 (68%) and 26 out of 26 (100%) women in the control and intervention groups, respectively, continued to breastfeed (P=.005). Results indicate that postpartum care augmented with individualized professional support commenced in the hospital and continued in the community significantly increases the duration of breastfeeding among women who identify themselves as being without support for the first month postpartum.

The effectiveness of a breastfeeding education intervention consisting of a 11/2-hour mandated session for all nursing staff, with an optional self-paced tutorial, was evaluated in a small rural Canadian hospital. The intervention was designed to increase exclusive breastfeeding rates, create positive beliefs and attitudes among staff members, and increase compliance with the World Health Organization/UNICEF Baby-Friendly Hospital Initiative (BFHI). Staff surveys and chart audits were conducted at both the intervention and control site hospitals prior to the intervention and 7 months after the intervention. Over a 7-month period, the intervention hospital experienced an increase in BFHI compliance (24.4 vs. 31.9, P<.01), breastfeeding beliefs (55.0 vs. 58.8, P<.05), and exclusive breastfeeding rates (31% vs. 54% of breastfed babies, P<.05) but no change in breastfeeding attitudes (44.0 vs. 44.9, P=.80). The control site experienced no change in BFHI compliance, beliefs, or attitudes but a significant decrease in exclusive breastfeeding rates (43% vs. 0%, P<.05).

A breastfeeding mother is confronted with a wide variety of over-the-counter products, necessitating careful guidance from her health care professional. This article presents a discussion and comprehensive tables that cover, by category, over-the-counter medications that nursing mothers may need to take. These tables should greatly assist the health care professional in the important task of counseling the nursing mother about the proper use of over-the-counter medications. This information will enable health care professionals to interpret information on the topic of over-the-counter medications and breastfeeding; list medications, in specific overthecounter categories, that are usually safe to take while breastfeeding; recommend overthecounter medications of choice for a breastfeeding mother; and generally counsel a breastfeeding mother who is taking or expects to take over-the-counter medications.

Latinowomen in Salt Lake City, Utah, have some of the lowest breastfeeding rates in the state. In an attempt to prolong breastfeeding duration in this population, the authors designed a new class to be taught by certified WIC (Special Supplemental Nutrition Program forWomen, Infants, and Children) personnel to pregnant Spanish-speaking participants. The class was designed after a literature review and onsite ethnographic research. The term la cuarentena del bebéWas introduced to signify the recommended 40 days when mothers should exclusively breastfeed, avoiding bottles, pacifiers, and supplementation. As part of the teaching model, class participants prepare an infant-feeding plan. Preliminary interviews show that WIC participants and staff view the newapproach as an improvement. Arandomized controlled trial is under way to evaluate the effectiveness of the class.

Lack of knowledge about the practical aspects of breastfeeding management is one of the major barriers to physician support of the breastfeeding dyad. Few physicians receive any training in lactation management during medical school. Because family physicians see both mothers and babies and often attend deliveries, they are in a unique position to care for breastfeeding mothers. This article describes a lactation management rotation for family medicine residents to prepare them to manage breastfeeding problems.

Breast milk donation (wet-nursing) for full-term babies is a well-known practice in Kuwait, but it has never been organized formally in a neonatal intensive care unit (NICU) for preterm babies. Donor milk banking as conducted inWestern society is not considered to be ethical in Muslim society, where the milk donor and the recipient are required to know each other. Human milk is known to decrease the incidence of necrotizing enterocolitis; improve host defenses, digestion, absorption of nutrients, gastrointestinal function, and neurodevelopment of the child; and contribute to maternal physical and psychological well-being. A culturally accepted approach to donor milk banking is proposed as a means of overcoming the ethical issues surrounding milk donation in Muslim society. This report addresses the first step in raising awareness of the valuable contribution of donor milk to preterm babies and the organization of human milk donation for use in an NICU.

Because many antibiotics are excreted into the breast milk, it can be difficult for a practitioner to choose an antibiotic for a lactating patient that will have minimal risks to her nursing infant. This article is the first of a three-part series discussing the use of anti-infective agents during lactation. The authors review general information regarding use and common side effects of several classes of antibiotics. They also summarize information, including documented milk concentrations, milk-to-plasma ratios, and other pharmacokinetic properties, in a table that can help practitioners choose antibiotics that may be considered safe for the lactating mother.