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Background and Significance: Breastfeeding problems are common; however, health care providers vary widely in their ability to address them effectively. Purpose: The purpose of this study was to identify the relative frequencies of common breastfeeding challenges and their associations with maternal well-being. Study Design and Methods: Women completed an online survey in which they described breastfeeding problems. Factor analysis was used to identify problems that co-occurred frequently, as well as the problems most strongly associated with maternal distress, maternal perceptions of greater severity, and postpartum depression or postpartum anxiety. Results: There were 535 responses to the online survey; of these, 457 answered the question about the nature of their breastfeeding difficulties. Pain with breastfeeding was the most common breastfeeding problem. Difficulties with milk supply and milk intake were most strongly associated with heightened maternal distress and perceptions of severity. Clinical Implications: Coordinated care for breastfeeding dyads, in which providers acknowledge the complex and reciprocal nature of many breastfeeding problems, has the potential to improve maternal satisfaction with breastfeeding as well as breastfeeding metrics. Breastfeeding challenges are common. In this study of over 450 new mothers who were recruited from social media, breastfeeding pain, nipple trauma, and perceived insufficient milk supply were the most frequently reported barriers to women reaching their breastfeeding goals. Nurses can use these data to advise women what to expect during breastfeeding and offer options prospectively that may help to avoid some of these situations. [ABSTRACT FROM AUTHOR]

Background: Mothers worldwide should exclusively breastfeed (EBF) their babies i.e. giving no other food or drink, not even water, except breast milk in the first six months of life. Third National Health and Morbidity Survey in 2006 have stated that the overall prevalence of EBF in Malaysia was 14.5% which is exclusively low. The objectives of this study were to investigate the current knowledge, attitude and practices (KAP) on EBF among Malaysian mothers. Methods: It was a cross-sectional questionnaire survey on EBF conducted among 115 mothers having child aged from six months to 12 months, who attended the Taman Maharani primary health care center in Muar during first quarter of 2016. Results: Response rate of the study was 87%. Overall 44%-53% mothers' knowledge on EBF was good to excellent, 71% had positive attitudes and only 52% mothers had good practice of EBF. Insufficient breast milk productions and resume back to work by the working mothers were the main barriers. Conclusions: Good knowledge and attitudes of mothers alone is not enough to enable mothers for EBF success. Though breast feeding is a natural act; it is a behaviour that needs to be learned. Support from immediate family members and health personal is essential to ensure and train mothers on EBF focusing simplicity and specificity. Mass media can play important role in increasing the KAP on EBF not only among mothers but also to the whole community. [ABSTRACT FROM AUTHOR]

Problem Although the World Health Organization and American Academy of Pediatrics recommend exclusive breastfeeding for the first six months, only 22% of U.S. mothers do so. Mothers’ perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. There are two changeable causes of PIM: (1) mothers’ misinterpretation of their infant’s behavior, and (2) mothers’ lack of confidence in their ability to breastfeed. Aim The purpose of this study was to evaluate the short-term effect of a home-based intervention designed to prevent and/or reduce PIM. Methods A mixed-methods, single-group, pretest-midtest-posttest design was used for evaluating a home-based breastfeeding program. The program was implemented during three 1.0- to 1.5-h home intervention sessions at 6, 13, and 27 days postpartum, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. Findings We found significant increases over time in mothers’ sensitivity to infant behavior and breastfeeding self-efficacy as well as significant decreased attribution of infant crying to PIM. Exit interviews indicated that the program was accepted by participating mothers. Discussion This is the first intervention study that has directly targeted the causes of PIM. The home-based intervention has the potential to add to maternal competencies both in correctly assessing their infants’ behavior, thereby preventing erroneous attribution of infant behavior to PIM, as well as simultaneously bolstering maternal confidence in breastfeeding skills. Conclusion By building maternal competencies, the home-based intervention has a longer-range potential to prevent breastfeeding discontinuation. Further evaluation is warranted. [ABSTRACT FROM AUTHOR]

Objective: to investigate the association between breast-feeding initiation and socio-demographic, lifestyle-related, clinical and lactation-related factors in a sample of mothers living in Greece. Design: cross-sectional study. Setting: Tertiary University Hospital, maternity ward. Participants: 428 mothers were interviewed (43.2% response rate) from February until December 2009, using a structured face-to-face questionnaire after at least 24 hours from childbirth. Measurements and findings: 71.0% of mothers were Greeks and 29.0% immigrants; the mean age was 32.0 years. 44.4% initiated exclusive breast feeding, 7.9% artificial milk-feeding and 47.7% partial feeding. In the multivariate analysis, exclusive breast feeding was inversely related to maternal body mass index (BMI) at the beginning of gestation (odds ratio (OR)=0.93, 95% confidence intervals (95%CI)=0.89–0.98) and caesarean section (OR=0.54, 95% CI=0.35–0.84). Lactation-related factors which favourably affected exclusive breast-feeding initiation included previous breast-feeding experience (OR=2.29, 95% CI=1.39–3.78), information about breast feeding (OR=2.38, 95% CI=1.41–4.01) and rooming-in (OR=1.62 95% CI=1.03–2.54), whilst any breast feeding was favourably affected by encouraging women to breast feed (OR=5.42, 95% CI=1.90–15.50), providing information about breast feeding (OR=6.92, 95% CI=2.53–18.89), and rooming-in (OR=6.93 95% CI=2.01–23.88), and negatively associated with caesarean section (OR=0.11, 95% CI=0.03– 0.39). Being an immigrant mother was also positively associated with any breast-feeding initiation (OR=7.97, 95% CI=1.02–62.19). Maternal age, education and income, as well as, smoking status, were not associated with any breast-feeding initiation. Key conclusions: maternal BMI and immigrant status, information provided by midwives and encouragement, rooming-in and mode of childbirth (caesarean section), were found to be important for breast-feeding initiation in this study population. No other indicator of socio-demographic status was found to be associated with breast-feeding initiation. Implications for practice: focus should be given to pregnant women with higher BMI at the beginning of pregnancy, and women who had undergone caesarean section. Breast-feeding information and encouragement should be provided to all women in the maternity ward, along with the dedicated practice of rooming-in, in order to promote and increase breast-feeding initiation rates. [ABSTRACT FROM AUTHOR]

Information about local breastfeeding rates and predictors of breastfeeding outcomes can assist with improving health planning and community support. Longitudinal infant feeding data were collected during scheduled contacts with a Community Child Health Nurse and a telephone survey at 6 months for 3828 infants in Perth, Western Australia. Breastfeeding rates were below recommended targets. Regression analyses identified several significant protective and risk predictors of breastfeeding outcomes. Factors that increased the likelihood of use of artificial baby milk in hospital were low birth weight, multiple births, private hospital, primiparity and mother of Asian ethnicity. At 6 months, factors that reduced the likelihood of breastfeeding were young mother, no tertiary education, multiple births, use of artificial baby milk in hospital, low birth weight and mother seeking postnatal professional breastfeeding advice within 14 days. A strong commitment by health leaders and professionals is required across the continuum of care to provide timely and consistent support to maintain breastfeeding. [ABSTRACT FROM AUTHOR]

The exclusive pickup and delivery problem with time windows (E-PDPTW), an NP-hard combinatorial optimization problem existed extensively in the transportation domain, was proposed. The mathematical description of this problem was proposed and its properties were analyzed, and then the problem was simplified as an asymmetric traveling salesman problem (TSP) with time windows. A two phase quick algorithm to solve single vehicle E-PDPTW was proposed, whose time complexity is only O (n³) and the test results indicate the algorithm is effective and quick. [ABSTRACT FROM AUTHOR]

• Maternal employment is major barrier to EBF in low & lower middle-income countries. • Enablers to EBF: good knowledge, home support, maternal leave, flexibility at work. • Barriers to EBF: caesarean section, discouragement & criticism, no support at work. This systematic review and narrative synthesis aims to explore the specific facilitators and barriers of exclusive breastfeeding (EBF) among employed mothers in low and lower middle-income countries. Primary quantitative and qualitative studies undertaken in low and lower middle-income countries published from 2003 to 2019 were included in the review. Two reviewers independently assessed each article for eligibility using standardized critical appraisal instruments from the Joanna Briggs Institute. Seven papers were included in this review. The enabler and barrier factors to EBF are summarized into three categories including maternal factors (such as mode of delivery, number of children, knowledge and attitude on breastfeeding), social factors (such as support from husband, family and child day care), and work-related factors (such as duration of maternal leave, flexibility of work, and availability of physical facilities). To increase EBF among employed women, employers should support them by offering flexible working hours, a minimum of six months maternity leave and providing breastfeeding facilities. Support from family and maternal factors were important factors that could positively affect EBF. Identification of modifiable barrier and facilitator factors may contribute to successful EBF in employed women thereby reducing mortality and morbidity in countries with limited resources. [ABSTRACT FROM AUTHOR]