Journal of Human Lactation

Eleven federally funded datasets assessing breastfeeding behaviors in the United States (Early Childhood Longitudinal Survey, Infant Feeding Practices Survey II, National Health and Nutrition Examination Survey, National Immunization Survey, National Survey of Children's Health, National Survey of Early Childhood Health, National Survey of Family Growth, Pediatric Nutrition Surveillance System, Pregnancy Nutrition Surveillance System, Pregnancy Risk Assessment Monitoring Survey, and WIC Participant and Program Characteristics) were reviewed to evaluate breastfeeding variables (initiation, duration and exclusivity) and determine whether relevant breastfeeding determinants were collected to evaluate breastfeeding practices from a health disparities perspective. The datasets used inconsistent breastfeeding definitions, limited ethnic descriptors, and varied regarding availability of relevant determinants. Multiple datasets collect breastfeeding data, but a coordinated US breastfeeding monitoring and surveillance system does not exist. Suggestions to improve this system include: standardizing breastfeeding definitions, expanding ethnic/racial descriptors, collecting additional relevant variables, and reducing recall periods. J Hum Lact. 25(2):139-150.

In 2003, the question, “Is the infant being breastfed at discharge?” was added to the US standard certificate of live birth. In Massachusetts, this was adapted to, “Are you breastfeeding or do you intend to?” In 2004-5, we compared the mother's answer to the birth certificate question in 2 hospitals, with her infant's feeding record. At Hospital A, 94.8% (290/306) of birth certificate responses matched the record. At (Baby-Friendly) Hospital B, 79.8% (185/232) matched. At the Baby-Friendly hospital, 17.2% (40/232) of women stated intent to formula feed on the birth certificate but breastfed postpartum. No significant sociodemographic differences existed between women whose answers matched or did not match. Although breastfeeding is a desirable health behavior, mothers did not overstate intent. The assumption that a prenatal feeding decision is an independent predictor of breastfeeding practice may be flawed. In the Baby-Friendly hospital, many women apparently made the decision postpartum. J Hum Lact. 25(2):151-156.

The purpose of this study was to identify what factors impact low-income women's infant feeding decisions. A cross-sectional convenience sample of 109 black pregnant women, ages 18 to 45, regularly attending Women, Infant, and Children (WIC) clinics and associated programs in the Inland Empire Region of California were recruited to complete a structured questionnaire about their breastfeeding beliefs and intentions. Multivariable logistic regression was used to explore participant's intentions to breastfeed. After adjusting for confounding factors, results indicate that women who attended support groups were more than twice as likely to intend to breastfeed compared with women who did not. These results highlight the importance of social influences on the decision to breastfeed, and indicate the need for broadened community-based education for the promotion of breastfeeding. J Hum Lact. 25(2):157-162.

The purpose of this study is to identify sources and acceptability of infant-feeding advice among participants in the US-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Focus groups are used to identify sources of infant-feeding advice and factors that contribute to acceptance of or resistance to that advice among 65 WICeligible mothers (34 English speaking and 31 Spanish speaking). The mothers primarily rely on experienced family and friends for advice and frequently use their own intuition to find solutions that work to solve real or perceived infant-feeding problems. Professional advice is perceived as credible when caregivers exhibit characteristics similar to those of experienced family and friends: confidence, empathy, respect, and calm. Using this information, it may be possible for WIC staff to make programmatic modifications to increase their ability to promote optimal infant-feeding behaviors in this population, thereby contributing to the reduction in the prevalence of childhood overweight. J Hum Lact. 25(2):163-172.

In-depth interviews were conducted with 44 low-income breastfeeding women to explore the incentives and disincentives to breastfeeding experienced within 6 months postpartum. Using an individual net benefit maximization (INBM) framework based on economic theory, we assessed women's motivations, incentives, and disincentives for breastfeeding. Based on the framework and their experience breastfeeding, women fell into 3 groups: intrinsically motivated, extrinsically motivated, and successfully experienced with both intrinsic and extrinsic motivation. Successfully experienced women were most likely to breastfeed to 6 months. Intrinsically motivated women valued breastfeeding but often required information and instruction to reach breastfeeding goals. Extrinsically motivated women were least likely to continue breastfeeding even with support and instruction. Providers can screen women to determine their experience and motivation then tailor interventions accordingly. Intrinsically motivated women may need support and instruction, extrinsically motivated women may benefit from motivational interviewing, and successfully experienced women may need only minimal breastfeeding counseling. J Hum Lact. 25(2):173-181

Six-month breastfeeding outcomes (almost exclusive breastfeeding, partial breastfeeding, and not breastfeeding) were analyzed for 201 infants born to Yolo County, California, mothers who returned to work or school. Twenty-two percent of workplaces and 17% of schools did not provide a lactation room. Although part- or full-time status, knowledge of breastfeeding rules, and support from colleagues were independently associated with the outcome, they were not significant in the multivariate analysis. In the selected model, maternal age (odds ratio [OR] = 2.3; 1.3-3.9 for a 10-year difference), college or above versus ≤ high school education (OR = 9.1; 4.2-19.6), and exclusive breast milk feeding in the hospital (OR = 2.1; 1.1-4.0) were associated with better breastfeeding outcomes at 6 months postpartum. Receipt of discharge gift packs containing formula (OR = 0.5; 0.3-1.0) was inversely associated with the degree of breastfeeding exclusivity. The 2 latter findings underscore the importance of hospitals adhering to specific guidelines of the Baby-Friendly Hospital Initiative. J Hum Lact. 25(2):182-193

In this preliminary prospective study, breast milk is sampled surrounding 4 religious fast days to determine the effect of a more than 24-hour fast on breast milk composition. The participants are 48 healthy women nursing healthy babies between 1 and 6 months of age. Samples are collected within 2 days before the fast (baseline), immediately after the fast, and 24 hours after fast completion. Samples are tested for sodium, calcium, phosphorus, triglycerides, total protein, and lactose. From baseline to immediately after fast, mean sodium, calcium, and protein levels increase (P = .013, P < .0001, and P < .0001, respectively) and mean phosphorus and lactose levels decrease (P < .0001 and P = .003, respectively). Mean triglycerides are unchanged. Twenty-four hours after fast, parameters are no longer significantly different from baseline except for elevated mean protein levels (P = .022) and lactose that is still reduced (P = .017). A fast of this nature is statistically associated with certain biochemical changes in breast milk. J Hum Lact. 25(2):194-198

Little is known about the safety of buprenorphine (BUP) in breastfeeding. The aim of this work was to investigate the transfer of buprenorphine and its main active metabolite, norbuprenorphine (n-BUP), into human milk and to determine the drug dose and effects in exposed infants. Seven lactating women, who were maintained on BUP treatment because of previous opiate addiction, were studied in an open observational study. All mothers had a strong wish to breastfeed their newborn infants. Buprenorphine samples for analysis were collected from the urine of 6 infants together with breast milk, blood, and urine from their mothers during a 24-hour period in the week after birth. One mother-infant pair was studied at 9 months of age. Buprenorphine and n-BUP were analyzed by a liquid chromatography/mass spectrometry method suitable for handling different matrices. Buprenorphine and n-BUP were found in low levels in the infants' urine. Breastfed infants were exposed to a calculated BUP dose per kg bodyweight less than 1%, with an average milk/plasma area under the curve of 1.7 (range, 1.1-2.8) for BUP and 0.7 (range, 0.4-1.2) for n-BUP. These data support the use of BUP during breastfeeding. However, the authors recommend that infants be monitored closely. J Hum Lact. 25(2):199-205.

Milk banks in Norway have a long tradition of using raw milk. This is a practice the authors hope to continue as they see it as the best choice until a child's own mothers' milk production is sufficient. Not only will the premature babies benefit from having milk from the bank, but if a mother, for any reason, can not supply her baby while it's in the hospital her baby should be offered milk from a bank. In Norway, with a high breastfeeding rate this can be done at many hospitals. J Hum Lact. 25(2):206-210

This represents the first published account from the patient's perspective of the use of human milk as cancer therapy. Purposive sampling was used to select a sample of 10 participants. Five were patients and 5 were family proxies. Individual interviews were conducted using confirmatory interviewing technique to obtain individual perspectives on the motivation for cancer patients to take donated human milk. Human milk therapy improved the quality of life (QOL) measures in the physical, psychological, and spiritual domains for most patients interviewed. The patients continued their use of human milk despite cost, taste, and discouragement from the conventional medical community. The study results support the theory that QOL may be more important to cancer patients than cancer outcomes and may improve patient medical care overall. These interviews offer information to cancer patients, their practitioners, and donor milk banks on outcomes and symptom relief from this therapy. J Hum Lact. 25(2):211-219

The Delphi technique provides a structured process for collecting and examining group agreement on a topic. It facilitates anonymity and thus reduces the risk of stronger members dominating the group discussion, and it allows geographical spread of the participants as well as low cost and timely return. This article describes the use of Delphi to examine agreement and lack of agreement among an expert panel on what skills a mother needs to learn for hand expression. A Delphi technique can be used for a variety of topics and participants. J Hum Lact. 25(2):220-225.

Today, more mothers in the United States are in the labor force, and returning to the workforce presents numerous challenges for the breastfeeding mother. Although it as been demonstrated that maternal employment is associated with a decrease in the length of time a mother continues to breastfeed, health care providers are in a unique position to enhance a mother's breastfeeding success as she transitions back into the workplace. This article describes various commonly perceived obstacles to combining breastfeeding and working and provides examples of information, anticipatory guidance, and support that health care providers can use to assist a breastfeeding mother with a successful return to the workforce. J Hum Lact. 25(2):226-232.