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Background: Breast engorgement is a major cause of pain and weaning in the early postpartum period. While protocols reinforce the need for anticipatory engorgement advice and continued outpatient health professional breastfeeding support, there remains limited information on the efficacy of focused postdischarge engorgement education. This study sought to explore if outpatient postpartum engorgement education changed mothers' home management and if mothers found instruction on specific massage and hand expression techniques helpful., Materials and Methods: This was a prospective descriptive cohort study. Subjects received engorgement-specific postpartum support from a healthcare professional at the posthospital discharge (PD) newborn visit. Email surveys at 1, 2, and 12 weeks postpartum collected data on engorgement home management, clinical course, and postpartum education., Results: After the office visit, mothers changed their engorgement home management. Significantly more mothers utilized massage toward the axillae (25% versus 1%, p ≤ 0.001), reverse pressure softening (18% versus 3%, p = 0.001), and feeding more frequently (32% versus 16%, p = 0.04). Sixty-one percent would not have used massage and hand expression before education in the office. At 12 weeks, 96% of women reported massage and hand expression instruction as helpful. Mothers reported engorgement peaked at a median of 5 days postpartum, corresponding well to the office visit at a median of 4 days postpartum., Conclusions: Maternal engorgement symptoms are commonly present at the PD newborn visit. Education on engorgement, massage, and hand expression at this visit significantly changes home management strategies. Mothers find massage and hand expression instruction helpful.

Purpose: Our objective was to pilot a method of engaging fathers/partners of high-risk inner-city mothers in breastfeeding support., Materials and Methods: Breast for Success was a breastfeeding promotion initiative with a father engagement component. In collaboration with Community Endeavors, Inc., we organized father-friendly evening programs (one night per week for 3 weeks, repeating quarterly) led by a male facilitator to provide breastfeeding education, with ongoing availability of a resource specialist to link men to community resources relevant to their legal, financial, and health needs. Fathers/partners were recruited from community programs and via our community partner, The City of Cleveland Department of Public Health MomsFirst™ Project, a federally funded Healthy Start program. University Hospitals Case Medical Center Institutional Review Board approved the study., Results: Sixty-six fathers/partners attended eight evening programs, and 30 (45%) attended all three nights. Their median age was 27.5 years (range, 17-64 years), and 49 (74%) self-described themselves as African American. At the start of the groups, 39% (21/54 responding) had a breastfed child, and 64% (39/61 responding) said they were comfortable with breastfeeding for their own child. After Sessions 1, 2, and 3, respectively, 40 (85%), 42 (89%), and 33 (80%) were "more likely" to want their next baby to breastfeed. On average, in 62% of all responses (278/450 possible), men endorsed learning "a lot more" about the 10 breastfeeding curriculum topics presented., Conclusions: Recruitment of inner-city fathers/partners for a breastfeeding education program was feasible, and among men who attended, fathers' perceptions about their breastfeeding knowledge were positively impacted.

This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.

Exclusive breastfeeding is the optimal method of infant feeding for the first 6 months of life for both term and preterm infants. This recommendation is based on indisputable evidence that breastfeeding offers numerous infant and maternal health benefits. Several trials have shown the beneficial effect of peer and/or professional support on the duration of any breastfeeding up to 6 months. Although many well-established programs exist that provide this support in-person or via telephone, the Internet is a relatively new means to deliver breastfeeding help. Yet, mothers have a vast presence online and a clear desire to seek healthcare information on the Internet. The availability and accessibility of interactive communication technologies via the internet provide the opportunity for developing new methods of healthcare delivery. Our project uses information technology to deliver an innovative and cost-effective way to support breastfeeding mothers. Our new online breastfeeding support clinic has the potential to improve access to specialized professional breastfeeding support in combination with interactive peer support. This new online clinic can be readily implemented to all regions in Canada with reliable Internet access, with the potential to significantly impact the health of all Canadian infants and their families.

Background: Breastfeeding within the first hour of life is a potential mechanism for health promotion and is considered to be an indicator of excellence of breastfeeding. This study was conducted to evaluate the knowledge, attitude, and practice regarding early breastfeeding initiation within the first hour of life in both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital, Minia, Egypt., Subjects and Methods: A study was conducted on four groups of participants from both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital, each of them consisting of 30 individuals, using a questionnaire to assess the knowledge, attitude, and practice regarding early breastfeeding initiation for each group., Results: Sixty percent of women delivered by spontaneous vaginal delivery and 16.7% of those delivered by cesarean section initiated breastfeeding within 30 minutes to 1 hour after birth. Forty percent of lactating women delivered by spontaneous vaginal delivery, 83.3% of lactating women delivered by cesarean section, and 36.7% of healthcare workers used prelacteal feed instead of early breastfeeding initiation. The most important factors affecting the breastfeeding initiation were maternal illness followed by immediate skin-to-skin contact., Conclusions: Although the majority of women participating in this study exhibited knowledge about early breastfeeding initiation, actual application of this practice was clearly deficient. In order to improve the rates of breastfeeding initiation within the first hour of life we should enhance vaginal delivery and prenatal classes and implement Baby-Friendly Hospital Initiative policies in both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital.

Despite the known health benefits for mother and infant, compliance with exclusive breastfeeding continues to challenge many healthcare providers. In an ongoing attempt to maintain the goals of the Healthy People 2010 initiative, our institution set out to identify patients with suboptimal breastfeeding rates in order to recognize potential barriers. Review of breastfeeding rates at the time of discharge noted significantly lower participation by clinic patients. In order to develop successful interventions, the aim of this study was to survey clinic patients to determine their intentions, attitudes, and obstacles to the practice of exclusive breastfeeding. In total, 188 surveys were completed during a 2-month time period. Respondents were primarily Hispanic (76.4% vs. 9.6% black and 8.4% white) and multiparous (57.5%) with a mean age of 25.7 years (range, 15-39 years old). Although 95.3% of respondents indicated that they believed breastmilk provided adequate nutrition, only 35.3% planned on exclusively breastfeeding. Access to free formula through the Special Supplemental Nutrition Program for Women, Infants and Children was the most common reason not to breastfeed (48.3%), followed by fear of pain and the need to return to work/school. Patients reported that the person with the greatest influence on their decision to breastfeed was their partner/spouse. Access to a lactation counselor was the most popular intervention requested, even among experienced multiparous patients (78.9% of whom had previously breastfed). In conclusion, the survey indicated that planned exclusive breastfeeding rates are low among this inner-city resident clinic and interventions should include involvement of the partners/spouses and access to lactational support.

This article is not a research study but rather a review of current understanding of the effects of childhood sexual abuse on the childbearing woman. Approximately one in four women has experienced early sexual abuse. Such a history can affect a woman's relationships with loved ones and care providers, contribute to her fears of labor and birth, and affect her ability to attach to her baby. It continues to challenge her on issues of breastfeeding and parenting. Care providers can benefit by recognizing some typical indicators of an abuse history and some of the elements in perinatal care that may become triggers for memories or adverse reactions for survivors of abuse, as well as learn some strategies for helping them. There are specific suggestions to help women survivors suffering with anxiety related to breastfeeding. How to recognize or ask about a history of sexual abuse and how to make it safe emotionally for a woman to share her story or disclose her fears are important so that the provider can collaborate with the woman to avoid re-traumatization.