Journal of Human Lactation

Research on using videoconferencing for breastfeeding support is limited.

Although European case reports have described videoconferencing for providing lactation support, this was the first study to assess the reliability and feasibility of home videoconferencing for breastfeeding assessment and support in the United States.

The study used 4 real-time, secure videoconferencing sessions to deliver lactation support to 10 mothers in the home. To assess interrater reliability, percentage agreement was calculated on LATCH assessment scores from telehealth and home-visit International Board Certified Lactation Consultants (IBCLCs) during the first 2 visits. Participants’ perceptions of satisfaction and the overall experiences were documented.

The percentage agreement on the 5 LATCH score dimensions ranged between 40% to 100% during the first visit and 80% to 100% during the second visit. To assess feasibility, participants reported their satisfaction with the technology and their perceptions of the videoconference consultation. All participants “strongly agreed” that they were comfortable talking about breastfeeding concerns using home videoconferencing.

The findings suggest videoconferencing can potentially be used to support breastfeeding mothers in their homes.

Strategies that promote higher exclusive breastfeeding rate and duration are highly recommended. To date, no study has tested the feasibility of Web-based monitoring among breastfeeding mothers.

To develop an interactive Web-based breastfeeding monitoring system (LACTOR) and examine its feasibility, usability, and acceptability among breastfeeding mothers.

A prospective, descriptive, mixed-methods study was conducted. Mothers who met the study inclusion criteria were recruited from mother infant units in 2 Midwestern hospitals in the United States. Mothers were asked to enter their breastfeeding data daily through the system for 30 days and then submit an online exit survey. This survey consisted of a system usability scale and mothers’ perceptions form. Twenty-six mother/infant dyads completed the study.

The Feasibility of LACTOR was established by mothers’ compliance in entering their breastfeeding data. The mean was 8.87 (SD = 1.21) daily entries, and the range was 6-13 times per day. Usability scale total mean score was 3.35 (SD = 0.33; scale range 0-4). Ninety-two percent of the mothers thought that they did not need to learn many skills before they started to use LACTOR and did not need any technical support. Mothers reported that the monitoring was beneficial and gave them the chance to track their infants’ feeding patterns and detect any problems early.

This study demonstrated the feasibility of LACTOR, and it was user-friendly and acceptable among mothers. Further studies to test its effect on breastfeeding outcomes are needed.

While hospital policies and medical issues are important factors in determining exclusive breastfeeding rates, medically unnecessary supplementation of infants is likely to be due, in part, to maternal request for formula.

The goal of this project was to gain an understanding of the facilitating factors and decision-making processes surrounding maternal request for formula in the early postpartum period.

A series of 12 focus groups were conducted among 97 English- and Spanish-speaking low-income participants in California’s Supplementary Nutrition Program for Women, Infants, and Children (WIC). Mothers were asked to share their in-hospital infant-feeding experiences.

The overarching theme that emerged was “lack of preparation” for what the early postpartum period would be like. Specifically, the decisions to formula feed fell into the following categories: inadequate preparation for newborn care (the need for rest and unrealistic expectations about infant behavior), lack of preparation for the process of breastfeeding, and formula as a solution to breastfeeding problems. Cultural factors were not mentioned as reasons for supplementation.

Interventions to promote in-hospital exclusive breastfeeding must address mothers’ real and perceived barriers, specifically mothers’ expectations related to breastfeeding and infant behavior.

Breastfeeding assessment in the hospital to determine adequacy of feeds remains controversial. Swallow evaluation is integral to current assessment tools, but the literature is not clear about whether the number of swallows is an accurate indicator of breast milk intake in early postpartum.

To determine the reliability and validity of swallows as a measure of breast milk intake in the first days of a newborn’s life.

Thirty mother-baby dyads were observed at one breastfeeding; pre- and postfeed weights were done, bedside audible swallows were counted, and feeds were videotaped for independent rating. Milk intake was determined from weight change, adjusted for insensible water loss.

Number of swallows was significantly and positively correlated with breast milk intake (r = .71). Number of swallows alone, however, accounted for only 50.8% (R² = .508) of the variation in milk intake. Infant age was the best predictor of milk intake (β_age = .56 vs β_{No. swallows} = .36), accounting for 68% of the variation in milk intake when combined with swallows. The majority of infants took in 10 g or less of breast milk (77%); length of feeds was variable. In-room (at bedside) lactation consultant (LC) and video rater LC swallow counts were significantly and positively correlated (r = .93; P < .01). However, the 2 lactation consultant swallow numbers include clinically important discrepancies in a Bland-Altman analysis.

Number of swallows was not supported as a reliable or valid indicator of milk intake and adequacy of a feed in the first few days of life.

Introducing solids foods to infants before 6 months has been associated with adverse long-term health outcomes. Studies and surveys frequently use maternal report to identify the age when infants start solid foods.

To address the accuracy of maternal report at 1 year postpartum regarding introduction of solid foods.

Between 2008 and 2009, the authors enrolled mothers of healthy term singletons at an urban Boston hospital within 72 hours of giving birth. We called mothers monthly for 6 months and asked if they had given their baby solid foods in the previous month. At 1 year, we contacted mothers again and asked when they first gave solid foods; answers at 1 year were compared with the data collected monthly.

The authors analyzed data on 157 women, all of whom had, according to monthly responses, started solid foods before 6 months. At 1 year, only 14% (22/157) of reports matched data recorded monthly. Although 100% of women introduced solids before 6 months, at 1 year, 41.4% reported starting solids at 6 months.

Among women who started feeding solids before 6 months, most did not give an accurate response at 1 year. Most said they started giving solids later than they did. Maternal report may not be the best way to collect such data, and health outcomes based on such data may be biased toward the null.

Postnatal unit rooming-in promotes breastfeeding. Previous research indicates that side-cars (3-sided bassinets that lock onto the maternal bed frame) facilitate breastfeeding after vaginal birth more than stand-alone bassinets (standard rooming-in). No study has previously investigated side-car bassinet use after cesarean, despite the constraints on maternal-infant interactions that are inherent in recovery from this birth mode.

To test the effect of the side-car bassinet on postnatal unit breastfeeding frequency and other maternal-infant behaviors compared to a stand-alone bassinet following cesarean birth.

Participants were recruited and prenatally randomized to receive the side-car or stand-alone bassinet for their postnatal unit stay between January 2007 and March 2009 in northeastern England. Mother-infant interactions were filmed over the second postpartum night. Participants completed face-to-face interviews before and after filming. The main outcome measures were infant location, bassinet acceptability, and breastfeeding frequency. Other outcomes assessed were breastfeeding effort, maternal-infant contact, sleep states, midwife presence, and infant risk.

Differences in breastfeeding frequency, maternal-infant sleep overlap, and midwife presence were not statistically significant. The 20 dyads allocated to side-car bassinets breastfed a median of 0.6 bouts/ hour compared to 0.4 bouts/hour for the 15 stand-alone bassinet dyads. Participants expressed overwhelming preference for the side-car bassinets. Bed sharing was equivalent between the groups, although the motivation for this practice may have differed. Infant handling was compromised with stand-alone bassinet use, including infants positioned on pillows while bed sharing with their sleeping mothers.

Women preferred the side-car, but differences in breastfeeding frequency were not statistically significant. More infant risks were observed with stand-alone bassinet use.

The continued ability for a mother to produce breast milk following the death of her baby in utero, at birth, or during the postpartum period is an aspect of perinatal loss that is rarely acknowledged.

To explore the lived experience of bereaved mothers who chose to express and donate their breast milk to a milk bank to feed premature and sick babies following the loss of their own babies.

Twenty-one bereaved mothers who donated their milk between January 2003 and December 2006 to the Mothers Milk Bank in San Jose, CA or Columbus, OH participated in an in-depth, semistructured interview process about their experiences expressing and donating their milk.

Each transcribed interview revealed 4 essential themes, as follows: (1) identifying as a mother, grieving the loss of motherhood; (2) meanings associated with the experience of pumping milk; (3) finding meaning in and integrating the experience of perinatal loss; and (4) the importance of addressing lactation with bereaved mothers. Various subthemes were explored within each essential theme.

The experiences of these participants reflect the importance of addressing lactation more thoroughly with bereaved mothers who have lost their babies in utero, at birth, or during the postpartum period and providing them with adequate support and education during the healing process.

Nipple pain is a major cause of early weaning. The causes of nipple pain are diverse, and most treatments involve experience-based assessment. There is little knowledge of the intensity or variation in pain experienced by breastfeeding women. Given the high breastfeeding initiation rates, it is important to evaluate pain experienced by lactating women in detail.

To investigate and compare the pain experienced by breastfeeding women using objective measures.

The type, effect, and severity of pain were measured using the McGill Pain Questionnaire, Brief Pain Inventory, and Visual Analogue Scale, respectively, for 2 groups of breastfeeding women. One group were experiencing persistent nipple pain despite treatment, and the other had obvious signs of nipple trauma.

Pain intensity and interference scores were highly variable for both groups. Mothers with nipple trauma reported significantly higher mean pain intensity and breastfeeding interference. Higher pain intensity scores were related to higher interference scores. After accounting for pain intensity, higher interference with general activity, mood, and sleep interference was related to longer duration of pain. There was no difference in MPQ class scores.

The ramifications of nipple pain extend far beyond the act of breastfeeding, particularly for women whose pain lasts several months. Given the lack of evidence-based treatments, it is not surprising that pain is a major contributor to premature weaning. Further research into the causes of nipple pain is necessary to enable the implementation of effective interventions, thus reducing further complications such as infection and postnatal depression. Detailed pain analysis may assist in assessing the success of these interventions.

Vascular endothelial growth factor (VEGF) and its receptors regulate angiogenesis (formation of blood vessels). The soluble VEGF receptor 1 (sFlt-1) binds VEGF as a potent antagonist.

The objective of this study was to compare VEGF and sFlt-1 levels in milk from mothers of preterm (n = 50) versus term (n = 49) infants in a longitudinal study.

Milk samples were collected on days 3 and 28 of lactation. Vascular endothelial growth factor and sFlt-1 were quantified by sandwich-type enzyme-linked immunosorbent assay.

Vascular endothelial growth factor and sFlt-1 were found in high concentrations in early milk (lactation day 3) from mothers of preterm and term infants and were lower in mature milk (lactation day 28). On day 3, median VEGF concentration was lower in preterm than in term milk (37.1 vs 53.9 ng/mL, P < .01). Otherwise, VEGF (day 28) and sFlt-1 (days 3 and 28) did not differ in preterm versus term milk.

It was shown for the first time that sFlt-1 is present in human milk. Early human milk contains high concentrations of VEGF and sFlt-1, which decrease over the course of lactation.

From animal studies, it is known that mastitic inflammation of the mammary lobes can produce proinflammatory cytokines and can damage the milk fat globule (MFG).

To investigate, in women, whether MFG and interleukin (IL)-6 differences are observed between mastitic milk (MM) and healthy milk (HM) of a mother.

MM was obtained from the specific nipple pore leading to the mastitic lobe of 17 women; HM was obtained from the other breast. Milk sampling occurred at days 0 (pre-treatment), 1, and 2 (post-treatment). MFG size and IL-6 were measured by laser light scattering and enzyme-linked immunosorbent assay, respectively. We analyzed MFG and IL-6 differences between HM and MM, whether any differences occurred over time with treatment, and whether differences were observed between mothers with systemic symptoms (fever/malaise, Group A) or without systemic symptoms (Group B).

On day 0, MM had higher MFG size (P < .01) and IL-6 levels (P < .001) than HM. This difference significantly decreased over time with treatment for both MFG size (P < .01) and IL-6 (P < .05). On day 0, Group A mothers had significantly larger MFG size (P < .01) and IL-6 (P < .001) than Group B.

MM contains larger MFG and higher IL-6 levels than milk from the healthy breast. This difference is larger if accompanied by systemic symptoms of mastitis (fever/malaise). These changes decreased over time with treatment. Therefore, early initiation of appropriate treatment may be useful in limiting the processes that contribute to alterations in MFG size and IL-6.

Infant feeding-related health outcomes need to be consistently defined prior to inclusion in health services research.

To categorize conditions common in infants under 12 months old by their association with breastfeeding for use as outcome measures in a randomized, controlled trial of breastfeeding promotion.

A modified Delphi consensus method synthesized opinions of 13 physician experts on breastfeeding’s association with ICD-9 infant diagnosis codes derived from literature review and medical center experience. A pilot round and 2 subsequent Delphi rounds were used. For the first round, consensus was achieved when more than 80% of experts agreed on a classification for a particular condition, with a predetermined level of certainty based on a 7-point Likert scale. For the second round, consensus was achieved when a majority of experts agreed on the classification from Round 1.

An initial 68 diagnosis codes were identified for evaluation by the expert panel. After a pilot round, the codes were refined and condensed, which resulted in 38 diagnoses for categorization into 1 of 3 categories: (1) breastfeeding protects against the condition; (2) breastfeeding may cause or worsen the condition; and (3) breastfeeding is unrelated to the condition. At the conclusion of the process, consensus was achieved on the classification of 31 conditions, and 7 conditions remained unclassified because of a lack of consensus.

This study provides a list of conditions common in infants under 12 months of age classified based on relationship to infant feeding method and validated by expert consensus. These conditions, based on readily available insurance claims data, contribute to the standardization of outcome measures used for health services research related to breastfeeding promotion.

Breast cancer risk increases during pregnancy and remains elevated for a number of years thereafter. Cancer-associated proteins that are secreted into breast milk may provide a means to detect cancer in the lactating breast or to assess future breast cancer risk.

To determine whether proteins linked to breast cancer would be differentially expressed in matched (both breasts from each participant) human milk samples collected from women with unilateral breast cancer.

Five cancer-associated proteins (basic fibroblast growth factor [bFGF], YKL-40, neutrophil gelatinase-associated lipocalin, and transforming growth factor β1 and β2) were analyzed in milk provided by 5 lactating women, 4 of whom were known to have cancer in 1 breast (and the opposite breast clinically disease free) at the time of milk collection and 1 who developed breast cancer 2 years after milk collection.

Expression was significantly higher for TGFβ2 (P = .03) and bFGF (P =.03) in the breasts with cancer.

These proteins may play a role in assessing a woman’s risk of pregnancy-associated breast cancer. Because of variable protein concentration among patients and the limited sample size, the results are considered preliminary.

To address the recognized low rates of breastfeeding in the United Kingdom (UK), a change in fundamental attitudes toward infant feeding might be required. This paper reports an exploration of women’s attitudes toward breastfeeding at different time points in the perinatal period, undertaken as part of a larger breastfeeding evaluation study.

To measure women’s infant feeding attitudes at 3 stages during the perinatal period to see whether, on average, they differed over time.

Using the 17-item Iowa Infant Feeding Attitudes Scale (IIFAS), this cross-sectional study measured the infant feeding attitudes of 866 UK women at 3 perinatal stages (20 and 35 weeks antenatally and 6 weeks postpartum).

Mean IIFAS scores were very similar, which shows that discrete groups of women at different time points in pregnancy and postpartum appear to have the same attitudes toward infant feeding. The predominance of scores lay in the mid-range at each of the time points, which may indicate women’s indecision or ambivalent feelings about infant feeding during pregnancy and the postpartum period.

Action must be undertaken to target the majority of women with mid-range scores whose ambivalence may respond positively to intervention programs. The challenge is to understand what would be appropriate and acceptable to this vulnerable group of women.

Understanding breastfeeding knowledge, attitudes, and exposures among nonpregnant youth who are likely to be future parents may provide significant pathways to successfully increasing breastfeeding as the normal, accepted way of feeding infants. However, based on a recent review of the literature, only 3 studies have assessed these factors in nonpregnant, young adults in the United States in the past 10 years.

The objective of this study was to gather more recent data regarding breastfeeding knowledge, attitudes, and prior exposure among undergraduate university students.

This was a cross-sectional survey, conducted in November 2010. A convenience sample, consisting of undergraduates in attendance in 2 sections of an introductory nutrition class at a large research university, was used for this project (N = 248).

Breastfeeding knowledge was relatively good. However, overall breastfeeding attitudes were more neutral, which appeared to be explained by the belief that breastfeeding is painful, restrictive, and inconvenient, both in general and specifically for the working mother. Though support for breastfeeding in public was low, men were significantly less likely than women to believe it to be embarrassing or unacceptable. In addition, breastfeeding attitudes were more positive among older students and those who were breastfed as infants. Those who were breastfed as infants were also significantly more likely to intend to breastfeed future children.

Though this sample indicates good breastfeeding knowledge, attitudes were more neutral, and support for breastfeeding in public appears low. This finding is contradictory and warrants further exploration.

Many mothers find it difficult to breastfeed exclusively for the recommended 6 months postpartum. The Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF) was developed to measure breastfeeding self-efficacy, an important predictor of breastfeeding outcomes.

To translate and psychometrically assess the BSES-SF among women in Croatia.

A convenience sample of 190 breastfeeding mothers was recruited from a Baby-Friendly hospital in Zagreb, Croatia. In-hospital mothers completed questionnaires that included the translated BSES-SF, Sense of Coherence Scale (SOC-13), and a demographic questionnaire. The follow-up questionnaires were administered to mothers at 1 and 6 months postpartum to determine their infant feeding method.

The mean total score of the Croatian version of the BSES-SF was 55 ± 7. The Cronbach α coefficient for internal consistency was 0.86, suggesting good reliability. In-hospital BSES-SF scores significantly predicted breastfeeding duration and exclusivity at 1 and 6 months postpartum, providing support for predictive validity. The BSES-SF scores were significantly correlated with the total SOC scores (r = 0.32, P < .001) and the SOC subscales of comprehensibility (r = 0.35, P < .001), manageability (r = 0.26, P < .001), and meaningfulness (r = 0.20, P = .005), providing support for construct validity.

This study provides evidence that the translated version of the BSES-SF may be a valid and reliable measure of breastfeeding self-efficacy among postpartum women in Croatia.