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Breastmilk is the best nutrition to reduce morbidity and mortality among infants with low birth weight (LBW). However, breastfeeding LBW infants during hospitalization is often problematic. Strategies to promote breastfeeding can be done through providing breastfeeding education and support. The purpose of this study was to identify effect of the “SATUPAS” program on breastmilk production, frequency of breastmilk expression, and partial breastfeeding. This study was a randomized controlled trial involving 82 mothers and their LBW infants, which were divided into the intervention group and the control group. Bivariate analysis using the Wilcoxon and Mann Whitney tests showed that there was a significant difference between breastmilk production (p = 0.001), frequency of breastmilk expression (p = 0.001), and partial breastfeeding (p = 0.001) between the control group and the intervention group. This study recommends the implementation of SATUPAS as a strategy to increase breastfeeding of LBW infants undergoing hospitalization.

Objective: American women are consistently tasked with breastfeeding, while returning to work, but little research examines how women perceive support in the workplace and their own working outcome...

In 2018, the national coverage of exclusive breastfeeding among infants aged 0-5 months in Indonesia was still low. The COVID-19 pandemic can be a challenge to increase the coverage of exclusive breastfeeding. This study investigated the association between sources of breastfeeding supports and exclusive breastfeeding practices among mothers with infants aged under 6 months during the COVID-19 pandemic in Indonesia. This study used a cross-sectional study design through an online survey from November 2, 2020, to February 8, 2021. A total of 248 subjects were obtained through convenience sampling. Data analysis was done by bivariate analysis using Chi-square or Fisher’s exact test. Most of the subjects were aged 18-34 years old (90.7%), had higher education level (86.7%), had household income range Rp.3,000,000 – Rp.7,199,999 (39.2%), lived in Java Island (83.1%), had an infant aged ≤ 4 months (76.2%), and had a baby boy (51.2%). The proportion of exclusive breastfeeding was 79.0%. The most common sources of breastfeeding support were obtained from husband (91.1%) and health workers (65.7%), followed by family (62.9%). No significant association was found among all support sources on breastfeeding with exclusive breastfeeding. However, the proportion of exclusive breastfeeding among mothers who received husband support (80.1%) was higher than those who did not (68.2%). The most convenient and feasible breastfeeding supports that mother could obtain during pandemics were home-based supports. Mothers, their husbands, and families should be the priority target for health professionals to provide preventive and promotive breastfeeding intervention.

Background: Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization. Research Aims: To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed. Methods: This was a prospective cross-sectional survey study. Through secure online survey, participants submitted ( N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics. Results: Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood. Conclusion: Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.

Objective: To evaluate the effects of a baby-led self-attachment breastfeeding support intervention on the prevalence and duration of exclusive breastfeeding and nipple pain at 3 days, 6 weeks, 3 m...

Background Despite the benefits of breastfeeding for women with Gestational Diabetes Mellitus (GDM) and their infants, breastfeeding is less likely to be performed by this group. This study aimed to examine the current levels of implementation of breastfeeding support to women with GDM in Japan and to clarify barriers to promoting breastfeeding among this population. Methods A 25-item questionnaire was developed by the authors to investigate the current levels of implementation of breastfeeding support for women with GDM provided in hospitals, and to explore barriers for promoting breastfeeding among these women. The questionnaire was sent to all 1046 hospitals facilitating childbirth in Japan. Descriptive statistics were used to analyze the quantitative data, and content analysis was used to analyze qualitative data from the open-ended questions. Results All 296 respondents were included in this study. Regarding breastfeeding support, 95.2% of the respondents provided general information on breastfeeding to GDM women during antenatal midwife consultations. However, the benefits of breastfeeding for preventing type 2 diabetes were addressed by only 48.0%. Likewise, although follow-up services (e.g., telephone support or breastfeeding consultations) were conducted in 88.9% of hospitals, only 50.7% of hospitals informed women that breastfeeding decreases the risk of developing type 2 diabetes after GDM. Regarding barriers, seven categories and 20 subcategories about promoting breastfeeding for women with GDM were extracted and abstracted into the following three themes: Barriers associated with mother and infant, Barriers associated with health professionals, and Organizational barriers. Conclusions In Japan, most hospitals that responded provided general breastfeeding support from the antenatal to postpartum periods. However, the benefits of breastfeeding in terms of preventing the incidence of type 2 diabetes following GDM were insufficiently communicated to women with GDM. Furthermore, there were numerous barriers to promoting breastfeeding among women with GDM.

Objective The study aimed to determine the effect of breastfeeding support through social media on women's breastfeeding self-efficacy. Methods A randomised controlled trial was conducted in the maternity unit of Aksaray University Education and Research Hospital, Turkey. Education and counselling on breastfeeding were given via WhatsApp to women in the intervention group. Women in the control group received routine breastfeeding teaching before discharge from hospital. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was administered to both groups immediately after birth and at 3 and 6 months postpartum. The study was completed by 31 women in the intervention group and 37 women in the control group. Results At 3 and 6 months there was a statistically significant difference in BSES-SF mean scores between the intervention and control groups (p < 0.05). BSES-SF scores in the intervention group were higher at 3 and 6 months compared with baseline, while BSES-SF scores in the control group were lower at 6 months compared with baseline. Conclusion Women's breastfeeding self-efficacy was improved through a social media-based teaching and counselling intervention. Health care professionals should make use of social media tools to improve women's breastfeeding self-efficacy and encourage continuity of breastfeeding.

Background: The negative effects of cesarean section on breastfeeding are a major global concern. Purpose: This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy. Setting: Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019. Study Design: The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann–Whitney U test, and the chi-square test. Results: The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p < .001). In addition, the mother’s need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p < .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p < .001). Conclusion: Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections.

Background Breast/Chestfeeding remains a public health issue for African Americans, and increased rates would mitigate many health disparities, thus promoting health equity. Research Aims To explore the interplay of generational familial roles and meaning (or value) ascribed to communicating infant feeding information across three generations. Method This prospective, cross-sectional qualitative study used an asset-driven approach and was guided by Black Feminist Thought and Symbolic Interactionism. African American women ( N = 35; 15 family triads/dyads), residing in the southeastern United States were interviewed. Data were analyzed using thematic analysis. Results The older two generations described their role using assertive yet nurturing terms, while the younger generation carefully discussed the flexibility between their familial roles. Emergent themes described the meaning each generation attributed to communicating infant feeding information: “My Responsibility,” “Comforting,” “Bonding Experience,” “She Cared,” and “Gained Wisdom.” Conclusions Our findings have potential to contribute to achieving health equity in African American families. Future breast/chestfeeding promotion efforts may benefit from reframing the current approach to including protection language and not solely support language. Lactation professionals should further recognize and support strengths and resource-richness of intergenerational infant feeding communication within African American families using strength-based, empowerment-oriented, and ethnically sensitive approaches.

Breastfeeding (BF) is the foundation of child health and has many benefits for both mother and child health. Increasing BF prevalence and duration is one of the priority tasks of the pediatric community, supported at the state level. The active promotion of infant formulas undoubtedly has a negative impact on BF prevalence. The article observes regulatory acts on breast milk substitutes marketing and the practice of BF supporting in the Russian Federation.

Background Ethnic Chinese mothers in Malaysia adhere to 30 days of traditional postpartum practices (the “confinement period”) aimed at recuperation after delivery. Recently there has been an emergence of confinement centres (CCs) where mothers stay and receive traditional confinement care. Ethnic Chinese mothers have low breastfeeding rates. There are concerns that practices in CCs could contribute to this but no data exists. We described mothers’ breastfeeding experiences at CCs and identified areas for potential improvement in breastfeeding support. Methods Ethnic Chinese mothers intending to breastfeed their healthy infants were recruited post-delivery between August and October 2017 then, at 1 and 6 months, they were telephone interviewed about their experience. For every participant going to a CC after the birth, another mother going home (“home”) for her confinement was recruited. Chi-square test was used to compare groups and multiple logistic regression was used to assess the effect of confinement place on exclusive breastfeeding. Results Of 187 mothers, 88 (47%) went to CCs. Significantly more were primipara and fewer had previous breastfeeding experience. Response rates for the 1- and 6- month interviews were 88% (CC) versus 97% (home); and 77% (CC) versus 87% (home) respectively. Exclusive breastfeeding rates were similar between the groups: 62% (CC) versus 56% (home) at 1 month (p = 0.4); and 37% (CC) versus 42% (home) at 6 months (p = 0.5). Multiple logistic regression did not show that CCs were a factor affecting exclusive breastfeeding rates at 1 month, (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 0.9, 3.3), or 6 months (aOR 0.9, 95% CI 0.4, 1.7). However, significantly more CC participants only fed expressed breast milk. Despite 66% of CC participants reporting that their centre supported breastfeeding, only 6 (8%) CC participants compared to 66 (69%) of home participants roomed-in with their baby (p Conclusions Breastfeeding rates appeared to be similar at CCs and at home during the confinement period, but there were gaps in how CCs supported breastfeeding. Targeted training to CC staff to support breastfeeding may result in better outcomes for mothers staying in CCs.

The objective of this integrative review was to assess birth and postpartum doulas' roles in supporting breastfeeding initiation and duration. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and Scopus were searched using the key terms doula and breastfeeding. Fourteen articles met inclusion criteria. Six key themes were identified. Doulas may acquire only modest amounts of lactation-specific education; however, doula care still enhances the breastfeeding care provided by health-care professionals. Doulas offer prenatal and intrapartum support that encourages breastfeeding initiation in the hospital, as well as providing breastfeeding support in the community and home settings. This reinforces the unique role of the doula in bolstering maternal–infant health. The effect of doulas on breastfeeding duration is less clear.

Breastfeeding is the “Gold standard” for infant feeding. There are several areas of biological superiority of breastfeeding and breast milk over artificial (formula) milk. Exclusive breast milk feeding is the suggested diet for term and untimely children to give ideal baby nourishment, basic immunological and mitigating advantages, and prevention from ailment and illnesses. The Baby-Friendly Hospital Initiative dispatched in1991, is an exertion by UNICEF and WHO to guarantee that all maternities, whether detached or in a medical clinic, become focuses of breastfeeding support. The present study aims to assess knowledge effect on postnatal mothers regarding baby friendly hospital initiative. A one group pretest posttest research design was conducted among 60 postnatal mothers. Convenient sampling technique was used to select samples. Structured knowledge questionnaire was used to assess the effectiveness of information booklet regarding Baby-Friendly Hospital Initiative among postnatal mothers. The present study attempted to evaluate the effectiveness of information booklet on Baby-Friendly Hospital Initiative among postnatal mothers of SMCH and found that 6(10%) had adequate, 9(15%) had moderate adequate knowledge and also 45(75%) had inadequate knowledge in pretest and 42(70%) had adequate, 12(20%) had moderate adequate knowledge and 6(10%) had inadequate knowledge in posttest and concluded that there was a significant improvement after administration of information booklet. Thus, information booklet was effective in improving the knowledge on Baby Friendly Hospital initiative among postnatal mothers.

Cel pracyDepresja poporodowa dotyka około 13 – 20% kobiet, depresja w okresie ciąży – 19% kobiet ciężarnych. W Polsce brakuje oferty pomocy dla tej grupy osób. W artykule zaprezentowano elementy pilotażowego programu „Macierzyństwo krok po kroku”, finansowanego przez gminę Miasto Gdańsk. Celem programu było zapewnienia gdańszczanom specjalistycznej opieki laktacyjnej i psychologicznej w okresie ciąży i w pierwszym roku życia dziecka.MetodaBadaniem objęto trzy grupy kobiet: 36 matek biorących udział w konsultacjach psychologicznych i terapii krótkoterminowej, 123 kobiet korzystających z porad laktacyjnych oraz 104 osoby z grupy kontrolnej. Do ewaluacji wykorzystano m.in. autorskie ankiety, Kwestionariusz Oceny Zdrowia Psychicznego GHQ – 28 Goldberga (Makowska & Merecz, 2011) oraz Parental Stress Index - 3rd version (Abidin, 1995).WynikiWyniki. Przeprowadzona ewaluacja wykazała istotne obniżenie symptomów zaburzeń zdrowia psychicznego zarówno w grupie kobiet korzystających z interwencji psychologicznej jak i z porad laktacyjnych. W grupie kobiet korzystających z interwencji psychologicznej zaobserwowano istotne obniżenie stresu rodzicielskiego.WnioskiPrzeprowadzone analizy pokazują, że wdrożony program charakteryzuje się wysoką skutecznością. Program może być odpowiedzią na planowane zmiany w standardach opieki okołoporodowej i kontynuowany w kolejnych latach.

This study emphasizes the perception of nursing mothers towards the support of midwives they receive regarding breastfeeding. This mixed-method study was done using a random sampling to determine the sample. The data in this study was obtained by distributing a questionnaire to the mothers of the babies. The quantitative data were analyzed using univariate by STATA software 12 S.E while the qualitative study was done to five midwives using an indept interview. The results obtained were that almost all mothers had a good perception of midwife support because they really received support since the antenatal period through antenatal classes. Therefore, it is recommended for midwives to be able to provide breastfeeding support early on, i.e., by conducting clear counseling about breastfeeding in the antenatal class

Support is identified as a key factor in the promotion and duration of breastfeeding. This descriptive qualitative study sought to explore public health nurses' experiences of supporting women to breastfeed in Irish community settings. Semi-structured interviews were conducted using a qualitative descriptive methodology. Braun and Clarke's six-phase thematic analysis was used to analyse the data. Following data analysis, three major themes emerged, which included: ‘To give them the best support’; ‘We need the help and support as well’; and ‘We've only a certain amount of time’. The findings reveal that public health nurses seek to provide the best support to breastfeeding women within the constraints of clinical practice. Although public health nurses perceive that they have internal and external sources of support, more is needed to enable them provide the best care for breastfeeding women in Ireland.

The benefits of human milk in preterm infants, a population at high risk for developing adverse outcomes for which breast milk is a protective factor, are widely acknowledged. However, preterms’ admission in a neonatal intensive care unit (NICU) and newborn’s clinical conditions have been described as significant barriers, leading to lower rates of breastfeeding initiation and duration. Healthcare workers play a crucial role in encouraging breastfeeding. We conducted a cross-sectional survey among nurses working in six Italian NICUs, exploring their knowledge and attitude towards breastfeeding. Although the majority of nurses had a specific breastfeeding education, our results show still some variations among answers regarding aspects of breastfeeding support in this setting. Specifically, family-centered care, transition feeding to the breast, and skin-to-skin practice, despite being extensively addressed by the Neo Baby-Friendly Hospital Initiative, are the items that highlighted a range of answers that could result in conflicting information to mothers. Conclusion: By underlining the gaps of knowledge and attitude towards breastfeeding of nurses working in NICUs, this study provides an insight into what needs to be improved, with the aim of promoting higher rates of breastfeeding in the preterm population.

Objective: Accessible community lactation support impacts a woman's breastfeeding success by offering timely intervention and solutions, thereby allowing mothers to achieve breastfeeding goals and improve overall breastfeeding rates. Although the impact of breastfeeding support has been well established, there is a lack of consistency in the development and evaluation of support models. This report examines two differing populations of Baby Café attendees. The study evaluated the mother's achievement of personal and nationally recommended breastfeeding goals, the frequency of attending a Baby Café, and their ratings of the program as helpful in solving breastfeeding problems. Methods: A total of 559 mothers attending two Baby Cafés, one in Massachusetts and the other in southern Texas, were surveyed when their babies were 6 months old and again over age 12 months. Actual breastfeeding duration was compared with the mothers' initially stated goals and American Academy of Pediatrics (AAP) recommended goals, and then evaluated against the number of Café attendances. The mother's rating of the Café for helpfulness was measured using a 1–5 effectiveness scale. Results: Results show that mothers attending either of the surveyed Baby Cafés that served distinctly different populations reported higher breastfeeding exclusivity rates and higher rates of 12-month breastfeeding duration than national rates reported by the Centers for Disease Control and Prevention (CDC). More than 70% of all mothers surveyed rated the Café as most effective. Conclusions: The Baby Café model was shown to be effective at helping mothers reach breastfeeding goals regardless of the Café's different geographical settings and the socioeconomic characteristics of the populations served.

ObjectiveThe study aims were to identify maternal perceptions about the influence of a hospital-based breastfeeding peer support group in addressing breastfeeding concerns, assisting them to achieve their breastfeeding goals, and providing additional benefits.MethodsA descriptive, cross-sectional, online survey was conducted with a convenience sample of women who attended a hospital's breastfeeding support group. Participants reported their breastfeeding concerns and breastfeeding goals prior to and after their attendance at the breastfeeding support group. Changes in reported breastfeeding concerns and breastfeeding goals were analyzed with chi-square statistics.ResultsAfter participating in the support group session, survey participants (N = 100) expressed less concern about latching (81%–66%), mother's milk production (77%–62%), breastfeeding while apart from infant (75%–65%), and all other reported breastfeeding concerns. Overall, participants reported the support group successfully addressed their concerns (92%, n = 89), provided adequate time for responses to their questions (87%, n = 87), and assisted them to achieve their breastfeeding goals (91%, n = 88). Over 90% of participants planned to exclusively breastfeed through 6 months.ConclusionHospital-based breastfeeding support groups can successfully address mothers’ key breastfeeding concerns and support extended duration of breastfeeding.

Breastfeeding support is an important task of paediatric care. The high awareness of the female population about the importance of breastfeeding contributes to the formation of lactation dominant among women in the future. The level of information in support and recovery of breastfeeding (relaktation) in a motivated female audience has been studied. The readiness of women to use the additional feeding system, which simulates breastfeeding, to increase lactation and relation has been analysed. The study was conducted on the basis of the questionnaire results of 100 female students of the medical university, 56 paediatricians of the advanced training course, as well as 56 maternity women on 2–5 days after childbirth. Previously, students at a high scientific and practical level were informed about the disadvantages of artificial nutrition and the benefits of breastfeeding, including from the perspective of modern scientific research into the components of breast milk as living tissue. The doctors’ questionnaire was preceded by a practical lesson and a lecture on breastfeeding support and possible ways of relation. The participation of all the respondents in the study was exclusively voluntary. In the student and medical environment, the prevalence of awareness in the formation of a high commitment to breastfeeding has been revealed. In contrast, in a group of maternity women with a high level of lactation dominant, a single notification of relacement and the application of an additional Medela SNS feeding system did not achieve the desired indicators of motivation for breast feeding.

Background Infants, young children, and their mothers are vulnerable in humanitarian emergencies. The health benefits of optimal breastfeeding practices in emergency settings have been demonstrated by many researchers. Infant and Young Children Feeding in Emergency guidelines illustrate a series of interventions to protect, promote, and support breastfeeding, but unfortunately, these recommendations are still scarcely applied. Research Aims (1) To review the literature describing the effectiveness of breastfeeding protection, promotion, and support interventions in humanitarian emergency contexts; (2) to describe the influence of interventions on breastfeeding initiation, exclusivity, and duration; and (3) to evaluate relevant mother and infant/child outcomes available in the literature. Methods PubMed, CINAHL, Cochrane Library, Psychology Database, JSTOR, Web of Science, EMBASE, and Ovid were searched for articles that examined breastfeeding protection, promotion, or support interventions and the resulting outcomes without any time limits ( N = 10). Articles that did not include the interventions and related outcomes were excluded ( n = 1,391). Results Improved breastfeeding outcomes were reported in four (40%) papers, and three (30%) highlighted a behavioral change in infant and young child feeding practices following the implementation of the interventions. Increased knowledge about appropriate infant and young child feeding practices among mothers and humanitarian/health staff was reported in eight (80%) papers. However, outcomes were sometimes only generically reported, and some of the included papers had a low strength of evidence. Conclusion In the literature, there is a great dearth of studies evaluating the influence of interventions aimed at improving breastfeeding in emergency settings. More evidence is urgently needed to encourage and implement optimal breastfeeding practices.

Breastfeeding groups have been identified in national and international policy as an important support mechanism for increasing breastfeeding duration. The aim of this study was to estimate the value of public health nurse- (PHN) facilitated breastfeeding group support. The study was informed by methodology used to calculate a social return on investment (SROI). Data were collected from primary and secondary stakeholders using focus group, joint and individual interviews. Mothers reported improved mental health and increased duration of breastfeeding, and PHNs reported being more knowledgeable about breastfeeding, being able to offer a better service and experiencing higher job satisfaction. PHNs who did not facilitate groups but whose clients attended reported reduced workload and improvements in access to information. Family and friends reported more positive attitudes to breastfeeding. PHN-facilitated breastfeeding groups have benefits for mothers, PHNs and for society; therefore, a more systematised and geographically equitable approach to their implementation in Ireland should be promoted.

Background In China, the prevalence of exclusive breastfeeding at 6 months was only 20.8%. In promoting breastfeeding for newborns, a number of strategies have been initiated by Chinese government. These actions facilitated a high breastfeeding initiation of 77 to 99.9% in different regions. However, the exclusive breastfeeding rates remained low at 6 months resulting from a high rate of perceived insufficient breast milk and complementary feeding during the early days after childbirth. The aim of this study was to understand the experiences of women in Shenzhen with regard to breastfeeding in the first 6 weeks after giving birth, to identify the facilitators and barriers impacting their breastfeeding decisions and to identify their perceived support needs that might facilitate breastfeeding in the future. Methods This was a qualitative exploratory study. Data were collected in November 2018 through semi-structured, face-to-face, in-depth interviews. A purposive sample of early postpartum women was recruited from a postpartum clinic of a tertiary maternal hospital in Shenzhen, China. The dataset was analysed using inductive content analysis. Results A total of 22women were interviewed within the first 6 weeks after delivery. Three themes related to breastfeeding were identified from the transcribed interviews: “breastfeeding facilitators,” “breastfeeding barriers,” and “recommendations for breastfeeding promotion.” Conclusions Women experienced both joy and suffering in their journey of breastfeeding. Insufficient knowledge of breastfeeding, discomfort, intergenerational disagreements regarding nutritional supplements, and a lack of professional support contributed to difficulties and the threat of discontinuation. A supportive environment for breastfeeding is crucial for women’s decision on exclusive breastfeeding and the psychological wellbeing of breastfeeding women. Interventions that target to promote exclusive breastfeeding should include both new mothers and significant family members. Future studies could test the effectiveness of breastfeeding training for home visit nurses to promote exclusive breastfeeding in the early postpartum.

Objective To synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally. Data Sources We used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies. Study Selection We included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review. Data Extraction We abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings. Data Synthesis We categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages. Conclusion We found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.

Objective To critically review and summarize the results of published articles on fathers' perspectives regarding breastfeeding support for their partners. Data Sources We searched the following databases for articles published between January 2010 and May 2019: CINAHL, MEDLINE, PubMed, Scopus, Web of Science, ThaiJo, and ThaiLis. We included articles published in English and Thai. Study Selection After duplicates were removed, our initial search yielded 3,927 articles. We excluded articles in accordance with pre-established criteria. We performed a quality appraisal of the selected full-text articles and ultimately included 27 in this review. Data Extraction We analyzed studies that met inclusion criteria and extracted and organized data related to fathers' perspectives on breastfeeding support into a structured table. Data Synthesis The data were synthesized into three themes: Attitude Toward Breastfeeding, Knowledge of Breastfeeding, and Fathers' Perceptions of the Breastfeeding Support They Provided. Conclusion Our results showed that fathers' perspectives on breastfeeding support were shaped by their knowledge of breastfeeding and participation in the breastfeeding process. To promote breastfeeding, further research is required to design and implement appropriate interventions to help fathers effectively support their breastfeeding partners.

The review analyses the available literature on the main principles of breastfeeding support in cases of confirmed/suspected novel coronavirus infection in breastfeeding mothers. Various approaches to management of mother and baby in the conditions of the COVID-19 pandemic have been studied that found reflection in the protocols of the World Health Organization, Chinese, American and European medical communities. The evolution of Russian recommendations is analysed. A rationale is offered for the current guidelines on temporary mother-child separation in the healthcare settings when maternal COVID-19 is suspected/confirmed and on the organization of infant feeding with expressed maternal milk. The literature on the nutritional and biological value and the safety of expressed breast milk stored in various conditions is reviewed. Practical advice is given on organization of an individual breast milk bank at home. Key words: breastfeeding, breast milk, individual milk bank, coronavirus infection, newborns, COVID-19 pandemic, breast milk expression

Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding ‘support’ could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional ‘antennae’ if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters.

We show that children who are born at the weekend or just before are less likely to be breastfed, owing to poorer breastfeeding support services in hospitals at weekends. We use this variation to estimate the effect of breastfeeding on children's development in the first seven years of life, for a sample of uncomplicated births of low educated mothers. We find large effects of breastfeeding on children's cognitive development, with much weaker evidence of effects on non-cognitive development, and no effects on health during the period of childhood we consider. Regarding mechanisms, we also study how breastfeeding affects parental investments in the child and the quality of the mother-child relationship.

Exclusive breastfeeding for the first 6 months and then alongside solid food for the first 2 years and beyond is the gold standard in young child nutrition. There is an abundance of literature relating to the preventative nature of breastmilk and breastfeeding against many infectious diseases and chronic conditions. However, despite medically complex infants and children being a group that could benefit most from continued breastfeeding, breastfeeding duration and exclusivity are lower among more complex paediatric populations. The reasons for this are not well known, and there is a paucity of data relating to supporting infants who have acute or chronic illness, disability or congenital anomaly to breastfeed. This systematic review aimed to understand the challenges of breast/chestfeeding the medically complex child and to establish the gaps in healthcare provision that act as barriers to optimal infant and young child feeding. The search was limited to studies published in English, focused on breastfed sick infants in hospital, with no date limits as there is no previous systematic review. Of 786 papers retrieved, 11 studies were included for review, and seven themes identified. Themes included practical and psychological challenges of continuing to breastfeed in a hospital setting, complications of the condition making breastfeeding difficult, lack of specialist breastfeeding support from hospital staff and a lack of availability of specialist equipment to support complex breastfeeding. The findings affirm the lack of consistent high‐quality care for lactation support in paediatric settings and reinforce the need for further focused research in this area.

Background The COVID-19 pandemic has hugely impacted upon people’s psychological and physical wellbeing; however, the effects of the COVID-19 lockdown on mothers of young children, with particular regard to breastfeeding, are unknown. Research Aims To explore: (1) Sources of advice and support available to breastfeeding mothers during and prior to the COVID-19 lockdown; (2) Mothers’ opinions on statements and recommendations made by the World Health Organization on the importance of breastfeeding and breastfeeding during the COVID-19 pandemic; (3) Maternal emotional states (i.e., anxiety and depression symptoms) experienced by breastfeeding mothers during the COVID-19 lockdown; and (4) influence of breastfeeding duration and number of children on breastfeeding opinions and emotional states. Methods Mothers of children aged 0–36 months ( N = 4018) took part in an online survey. The survey included demographic questions, as well as the Generalised Anxiety Disorder Questionnaire and the Patient Health Questionnaire. Mothers were further probed on opinions regarding breastfeeding practices during the COVID-19 pandemic. Results Participants strongly agreed with the importance of breastfeeding, even if a mother showed symptoms of COVID-19. Differences in opinions on breastfeeding practices (e.g., the use of donor human milk and relactation), were found between participants in relation to breastfeeding duration and number of children. Participants with more than one child showed higher negative emotional states, namely anxiety symptoms. Except for Internet usage, participants indicated a decline in all sources of advice and support for breastfeeding during the COVID-19 lockdown. Conclusions Health bodies and professionals should consider maternal viewpoints and opinions regarding breastfeeding during the COVID-19 pandemic. Interventions are urgently needed in order to support breastfeeding mothers and prevent the development of mental health issues.

Acute malnutrition in infants under 6 months (u6m) is increasingly recognised as a global public health problem. The World Health Organisation (WHO) guidelines for inpatient nutritional rehabilitation of infants u6m is re‐lactation: the re‐establishment of exclusive breastfeeding. Evidence suggests these guidelines are rarely followed in many low‐income settings. Two studies of infant nutritional rehabilitation undertaken in three public hospitals in coastal Kenya employed breastfeeding peer supporters (BFPSs) to facilitate WHO guideline implementation. To explore the acceptability of the strategy to health workers (HWs) and the BFPSs, in‐depth interviews were conducted with 20 HWs and five BFPSs in the three study hospitals. The HWs reported that the presence of the BFPSs changed the way infant nutritional rehabilitation was managed, increasing efforts at relactation and decreasing reliance on supplemental milk. BFPSs were said to help address staff shortages and had dedicated time to support and assist the mothers. Key to the success of the BFPSs was the social relationships they were able to establish with the mothers due to the similarity in their experiences and backgrounds. Despite the success of the BFPSs, human resource management and infrastructure challenges remained. BFPSs can successfully be employed to facilitate the implementation of the WHO guidelines for the nutritional rehabilitation of acutely malnourished infants u6m in hospitals in Kenya, establishing supportive social relationships and trust with the mothers of the acutely malnourished infants and helping to address the issue of human resource shortages.

INTRODUCTION The Ten Steps to Successful Breastfeeding are evidence-based practices used to improve breastfeeding outcomes, and most are to be implemented shortly after birth. Although breastfeeding is increasing in the United States, racial disparities persist. Available national samples used to examine trends in maternity care rely on maternal recall, which may be subject to error and bias. Thus, we conducted a pilot study to determine the feasibility of a large-scale study conducted during the birth hospitalization to explore patterns in practices supporting breastfeeding across maternal racial and ethnic groups. METHODS A convenience sample of 37 women with healthy, term singletons who intended to breastfeed were recruited from 2 academic medical centers (one in the Midwest and the other in the Pacific Northeast) and surveyed during their birth hospitalizations between July and November 2016. Women were asked whether they received the 7 steps that are recommended to be implemented shortly after birth (eg, encourage breastfeeding on demand). We generated descriptive statistics and conducted independent chi-square tests to determine associations between self-reported exposure to these 7 practices and race and ethnicity. RESULTS In this sample, 23 women (62.2%) were non-Hispanic white, 5 (13.5%) were non-Hispanic black, and 6 (16.2%) were Hispanic. Approximately 26 (70.3%) reported experiencing at least 6 of the 7 practices. Non-Hispanic white women were significantly more likely to room-in with their newborns, were less likely to receive formula, and were less likely to receive pacifiers than women of other races and ethnicities (P < .05). Furthermore, differences in exposure to practices by maternal race/ethnicity appeared more pronounced at one center than the other. DISCUSSION Preliminary findings suggest that some practices used to improve breastfeeding may be provided inconsistently across maternal racial and ethnic groups. Additional investigation is needed to further explore these patterns and to identify reasons for any inconsistencies in order to reduce health disparities in the United States.

Background: Breastfeeding is a critical first step on a child’s path to a healthy future. Despite its benefits, breastfeeding is no longer a norm in many communities. Inadequate support and lack of information by healthcare professionals were risk factors affecting breastfeeding failure. Although many studies identified knowledge and attitudes towards breastfeeding among mothers, little is known about knowledge and attitudes towards breastfeeding among medical and nursing students in Egypt. Aim: This study is aiming to assess knowledge, attitude and anticipated practices of medical and nursing female students at Al-Azhar University to provide breastfeeding support. Participants and methods: A cross sectional study, conducted at Al-Azhar University in Cairo during the academic year (2018-2019) on a sample of 440 female students from faculty of medicine and faculty of nursing. Results: Regarding knowledge, the finding of the study revealed very good level of knowledge (mean percent score of knowledge was 75.23%±7.37) and most of studied groups had neutral attitude (78.4%). Mean score of anticipated practices among them was 63.97±6.64 indicating average level. Conclusion and recommendation: This study reflects very good level of knowledge, neutral attitude and average anticipated practices level among undergraduate female students in medical and nursing faculties at Al-Azhar University. So, it is crucial to focus on students’ education and training as a fundamental aspect in improving future health care providers’ knowledge, skills and experience needed in clinical practice. This will affect students’ attitudes towards breastfeeding and will reflect on their anticipated practices.

Background Although the reasons for discontinued breastfeeding are multifactorial, an unsupportive work environment is consistently reported as a barrier to continued breastfeeding. In the United States, several state breastfeeding advocates have taken a distinctive approach to promote worksite lactation support by developing statewide recognition initiatives aimed at incentivizing employers to support breastfeeding employees by offering public recognition for the worksites’ efforts. Research aim To identify and describe statewide worksite lactation support recognition initiatives in the United States. Methods Between May 2016 and June 2017, semi-structured phone interviews were conducted with breastfeeding experts in each U.S. state ( N = 60 participants) for this cross-sectional study. Experts in states with a recognition initiative were asked about the background, structure, and requirements of the initiative. Results Twenty-six states had a current initiative, and some had requirements for providing a private space ( n = 19; 73%) and time ( n = 18; 69%) for employees to express human milk, as well as a written worksite lactation support policy ( n = 10; 38%). Conclusions This was the first study in which researchers systematically identified ongoing worksite lactation support recognition initiatives in the United States. The results of this work also served to highlight both the similarities and the variety between initiatives. Future researchers should aim to determine the components of an initiative that increase employer support and, in turn, breastfeeding rates.

Exclusive breastfeeding (EBF)—giving infants only breast-milk (and medications, oral rehydration salts and vitamins as needed) with no additional food or drink for their first six months of life—is one of the most effective strategies for preventing child mortality1–4. Despite these advantages, only 37% of infants under 6 months of age in Africa were exclusively breastfed in 20175, and the practice of EBF varies by population. Here, we present a fine-scale geospatial analysis of EBF prevalence and trends in 49 African countries from 2000–2017, providing policy-relevant administrative- and national-level estimates. Previous national-level analyses found that most countries will not meet the World Health Organization’s Global Nutrition Target of 50% EBF prevalence by 20256. Our analyses show that even fewer will achieve this ambition in all subnational areas. Our estimates provide the ability to visualize subnational EBF variability and identify populations in need of additional breastfeeding support., Exclusive breastfeeding in Africa is highly varied within and between countries, with many countries unlikely to reach World Health Organization 2025 targets without urgent action.

Background In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4–5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices. Research aim To identify the main barriers to optimal breastfeeding practices in Armenia. Methods We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches. Results We identified two main categories of barriers to optimal breastfeeding—systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers—mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers. Conclusion Optimal breastfeeding is crucial for the best start to an infant’s life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.

Background Physicians and nurses are expected to support breastfeeding mothers. However, there is a lack of standardized lactation education throughout training programs and hospitals. As a result, providers lack the necessary confidence and skills to guide mothers throughout the breastfeeding experience. The hands-on nature of breastfeeding management demands the implementation of application-based learning tools to improve skills retention and patient breastfeeding outcomes. Research aim In this scoping review, we aimed to critically assess the types of application-based breastfeeding management learning tools reported within medical and nursing professions and the evaluation methods of learner and patient outcomes. Methods The authors searched the literature to identify peer-reviewed articles published between 2000 and 2018 with medical or nursing students, residents, or professionals as the target learner group in an application-based educational intervention. Both authors independently assessed the content in the resulting articles, with specific focus on teaching methods, curricular development, and the learning outcomes reported within each study. Results Ten articles matched the inclusion criteria and were included in the final review, including five studies from the medical field and five from the field of nursing. Use of real patients was a common method for application-based skills training, followed by role playing and use of standardized patients. Teaching and evaluation methods varied widely across the studies. Conclusion The results align with existing literature in finding a dearth of high-quality studies assessing breastfeeding education among physicians and nurses. The variability in teaching and evaluation methods indicates a lack of standardization in breastfeeding education between institutions.

Background: Numerous efforts to promote breastfeeding resulted in a steady increase in the rates of breastfeeding initiation and duration. Increasing numbers of breastfeeding interventions are focused on breastfeeding maintenance and exclusivity and based on behavioral theories. Few studies critically analyzed the use of theories in breastfeeding intervention development and evaluation. Research aim: The aim of this critical review was to examine the existing literature about breastfeeding intervention, and investigate the role of theory in its development, implementation, and evaluation to provide future directions and implications for breastfeeding interventions. Methods: This critical review examined the existing breastfeeding intervention studies that used self-efficacy theories (SE), theory of planned behavior (TPB), and social cognitive theory (SCT) and were published during the past decade. Using five databases, studies in which researchers explicitly applied these three theories to frame the intervention were selected. Studies were critically reviewed for fidelity to theory in intervention design, delivery, and evaluation. Results: Eighteen studies were reviewed: nine SE-, five TPB-, and four SCT-based. Most interventions were focused on building mothers’ breastfeeding self-efficacy to improve breastfeeding exclusivity and duration. To achieve this goal, researchers who developed SE-based interventions used individual approaches, whereas other researchers who based studies on TPB incorporated social and environmental changes. SE-based studies were more likely to include theory-based instruments, but TPB- and SCT-based studies demonstrated less consistent choices of measurement. Researchers in most studies did not test the relationships between the proposed theoretical constructs and breastfeeding outcomes as guided by theories. Inconsistent outcomes resulted among the studies due to variations in study follow-ups. Conclusion: Sound applications of single or multiple theories demonstrate a great potential to help practitioners and researchers develop effective breastfeeding interventions and evaluate true impacts on positive breastfeeding outcomes.

The literature on growth assessment in infancy suggests that, while it is an important tool for defining health and nutritional status, there are concerns about potential negative effects from too frequent monitoring. The overall aim of this study was to estimate the value of public health nurse-facilitated breastfeeding group support in Ireland. The study was informed by, and is coherent with, the methodology used to calculate a social return on investment (SROI). Data were collected from primary and secondary stakeholders using focus group, joint and individual interviews (n=75) and questionnaire survey (n=139). Quantitative descriptive analysis of survey data and thematic analysis of qualitative data took place. Mothers viewed their infant's weight as an objective measure of their ability to breastfeed and highlighted its importance in counteracting negative commentary. Public health nurses suggested that mothers need to have confidence in their own ability rather than relying on an external measure of success. It is concluded that the voices of mothers need to be heard in any debate about what is helpful for them.

Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face‐to‐face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted.

Background: A team-based, integrated lactation consultant (LC) and primary care provider (PCP) program improves breastfeeding rates in some outpatient settings, but only a limited number of studies...

Background Breastfeeding rates for United States women with lower incomes fall below the government’s Healthy People 2020 Goals. Breastfeeding recommendations combined with support from providers and peer counselors help women decide to begin and sustain breastfeeding, but peer counselor uptake is low. Research Aim To evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention. Method In this pre-post intervention study (2015–2016; upstate New York), providers implemented a Toolkit to discuss infant feeding recommendations and initiate peer counselor referral. We surveyed women pre- and post-implementation (after delivery; 1 month postpartum) about prenatal breastfeeding intentions, provider support, and breastfeeding outcomes. Analyses controlled for secular trends. Results Pre-intervention ( n = 71) and post-intervention ( n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding support. Conclusions Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

Exclusive breastfeeding (EBF) during the first 6 months of life is crucial for optimizing child growth, development and survival, as well as the mother's wellbeing. Mother's employment may hinder optimal breastfeeding, especially in the first 6 months. We assessed the effectiveness of a baby‐friendly workplace support intervention on EBF in Kenya. This pre‐post intervention study was conducted between 2016 and 2018 on an agricultural farm in Kericho County. The intervention targeted pregnant/breastfeeding women residing on the farm and consisted of workplace support policies and programme interventions including providing breastfeeding flexi‐time and breaks for breastfeeding mothers; day‐care centres (crèches) for babies near the workplace and lactation centres with facilities for breast milk expression and storage at the crèches; creating awareness on available workplace support for breastfeeding policies; and home‐based nutritional counselling for pregnant and breastfeeding women. EBF was measured through 24‐h recall. The effect of the intervention on EBF was estimated using propensity score weighting. The study included 270 and 146 mother–child dyads in the nontreated (preintervention) group and treated (intervention) group, respectively. The prevalence of EBF was higher in the treated group (80.8%) than in the nontreated group (20.2%); corresponding to a fourfold increased probability of EBF [risk ratio (RR) 3.90; 95% confidence interval (CI) 2.95–5.15]. The effect of the intervention was stronger among children aged 3–5 months (RR 8.13; 95% CI 4.23–15.64) than among those aged

Objective. To assess breastfeeding support practices and related barriers and facilitators in a large Intensive Care Unit, Neonatal (NICU) in Medellín, Colombia, as part of a broader quality improvement initiative to enhance breastfeeding support. Methods. A mixed-methods descriptive design was used to collect data on care practices and outcomes related to NICU breastfeeding support. Data sources included the Neo-BFHI’s self-assessment questionnaire of breastfeeding policies and practices, clinical observations, and a retrospective review of 51 patient charts. Results. Of the 51 charts reviewed, 98% of the infants received breastmilk during their hospitalization but the majority (84%) also received formula and only 8% of infants were exclusively breastfed at the time of NICU discharge. All NICU staff received education on mother and baby-friendly care, and the unit complied with the International Code of Marketing of Breast-milk substitutes. However, resources to support lactation (e.g., access to breastfeeding specialists, breast pumps, written teaching materials for parents) were limited, and infants were only allowed to consume milk expressed within the hospital. Mother-infant separation, as well as staff beliefs and care routines, also limited important breastfeeding support practices such as skin-to-skin care and early initiation of direct breastfeeding. Conclusion. The self-assessment questionnaire and observations revealed a high value for breastfeeding and a family-centered approach to care in the NICU. Key challenges to sustaining breastfeeding in the NICU included a lack of facilities for supporting parental presence, barriers to expression and provision of mother’s milk, and a high rate of bottle-feeding with formula. Resumen Objetivo. valuar las prácticas de apoyo a la lactancia materna y las barreras y los facilitadores relacionados en una gran unidad de cuidados intensivos neonatal (UCIN) de Medellín, Colombia. Métodos. Se utilizó un diseño descriptivo de métodos mixtos para recopilar información sobre las prácticas de atención y los resultados relacionados con el apoyo a la lactancia materna en la UCIN. Las fuentes de datos incluyeron la encuesta de autoevaluación de las políticas y las prácticas de lactancia materna de Neo-BFHI, observaciones clínicas y una revisión retrospectiva de las historias clínicas de pacientes. Resultados. De las 51 historias clínicas revisadas, el 98% de los bebés recibieron leche materna durante su hospitalización, pero la mayoría (84%) también recibió fórmula y solo el 8% de los bebés fueron amamantados exclusivamente al momento del alta de la UCIN. Todo el personal recibió educación sobre cuidado amigable a las madres y sus bebés, y la unidad cumplió con el Código Internacional de Comercialización de Sustitutos de la Leche Materna. Sin embargo, los recursos para apoyar la lactancia (por ejemplo, el acceso a especialistas, extractores de leche, material didáctico escrito para los padres) fueron limitados y los bebés solo podían consumir leche extraída dentro del hospital. La separación madre-hijo, así como las creencias del personal y las rutinas de atención, también limitaron prácticas importantes de apoyo como el cuidado piel con piel y el inicio temprano de la lactancia materna directa. Conclusión. El cuestionario de autoevaluación y las observaciones revelaron un alto valor de la lactancia materna y un enfoque de atención centrado en la familia en la UCIN. Los desafíos clave incluyeron la falta de instalaciones para apoyar la presencia de los padres, las barreras para la extracción y el suministro de leche y una alta tasa de alimentación con biberón con fórmula. Resumo Objetivo. Avaliar as práticas de apoio à amamentação e as barreiras e facilitadores relacionados em uma grande Unidade de Terapia Intensiva Neonatal -UTIN- em Medellín, Colômbia. Métodos. Um desenho descritivo de métodos mistos foi usado para coletar informações sobre as práticas de cuidado e resultados relacionados ao apoio à amamentação na UTIN. As fontes de dados incluíram a Pesquisa de Autoavaliação de Políticas e Práticas de Amamentação da Neo-IHAC, observações clínicas e uma revisão retrospectiva dos registros dos pacientes. Resultados. Dos 51 prontuários analisados, 98% dos bebês receberam leite materno durante a internação, mas a maioria (84%) também recebeu fórmula e apenas 8% dos bebês foram amamentados exclusivamente na alta da UTIN. Todos os funcionários da UTIN receberam educação sobre cuidados amigáveis para mães e bebês, e a unidade estava em conformidade com o Código Internacional de Comercialização de Substitutos do Leite Materno. No entanto, os recursos para apoiar a amamentação (por exemplo, acesso a especialistas em amamentação, extratores de leite, materiais de treinamento escritos para os pais) eram limitados e os bebês só podiam consumir leite extraído dentro do hospital. As separações mães-bebês, bem como as crenças da equipe e rotinas de cuidado, também limitaram práticas importantes de apoio à amamentação, como cuidados pele a pele e início precoce da amamentação direta. Conclusão. O questionário de autoavaliação e as observações revelaram alto valor para a amamentação e uma abordagem centrada na família para o cuidado na UTIN. Os principais desafios para manter a amamentação na UTIN incluíram a falta de instalações para apoiar a presença dos pais, barreiras para extrair e fornecer leite materno e uma alta taxa de alimentação com mamadeira com fórmula.

Introduction: Colombia and Latin America in general show low rates of Exclusive Breast Feeding (EBF), which are far from the goal of 50% EBF by 2025 proposed by the World Health Organization (WHO) (1). Home-Based Breastfeeding Support Programs (HBSP) are a strategy created to strengthen adoption and adherence to EBF during the first 6 months, with the ultimate goal of providing the benefits of this practice and of preventing complications related to its absence (2). In 2012, the Keralty Group implemented an HBSP as one of its tools for postnatal care during the first 2 …

Background: Transient hypoglycemia affects up to 30% of newborn deliveries and is associated with significant risk of NICU admission, geographical separation from parents, and interruption of breastfeeding goals. Factors such as skin-to-skin contact and early feeding have been shown to promote successful breastfeeding and decrease NICU admission for neonatal hypoglycemia. While the World Health Organization, the American Academy of Pediatrics, and the National Institutes of Health agree that early breastfeeding is sufficient for otherwise healthy term infants, controversy exists regarding hospital policies for breastfeeding support, formula supplementation, and the use of dextrose gel to promote exclusive breastfeeding and reduce hypoglycemia related complications including NICU admission. Objective/Aims: …