Debbie Sheehan

The Ontario Mother and Infant Survey: Breastfeeding Outcomes

Across-sectional survey of postpartumwomen following discharge from five hospitals in Ontario, Canada, examined breastfeeding patterns and risk factors for early discontinuation. Consenting mothers completed self-administered questionnaires prior to discharge (n = 1250) and telephone interviews at 4 weeks postdischarge (n = 875). Breastfeeding initiation rates for women completing the interview varied from 82% to 96% across the sites. Continuation rates rapidly declined, with 13% to 24% ofwomen who had initiated breastfeeding switching to formula by 4 weeks postpartum. Perceived inadequate milk supply, difficulty with breastfeeding techniques, and sore nipples were the main reasons reported. Risk factors for breastfeeding cessation included not completing high school; intention to breastfeed less than 4 months; not anticipating the use of a “moms group” or “drop-in center”; one or more maternal visits to a family physician; length of postpartum stay greater than 48 hours; unmet need for care or help with breastfeeding; and received advice, information, or support about formula feeding.

The impact of a new universal postpartum program on breastfeeding outcomes.

The Ontario Mother and Infant Study II examined changes in postpartum health outcomes, including breastfeeding initiation and discontinuation, for mothers and their infants and compared these results to data collected prior to the initiation of the Universal Hospital Stay and Postpartum Home Visiting Program policy change in 1998. Data were collected using cross-sectional surveys before discharge and at 4 weeks postdischarge. Ninety percent of the women surveyed at 4 weeks postpartum initiated breastfeeding. Of these, 84% were still breastfeeding at 4 weeks postpartum. None of the 3 major program components—extended length of stay, a postpartum phone call from a public health worker, or a postpartum in-home visit—were associated with breastfeeding continuation to 4 weeks. Discontinuation before 4 weeks postdischarge was associated with maternal attitudes toward breastfeeding, formula feeding or supplementation in hospital, infant readmission, and use of walk-in clinics for infant care.

The Effect of Delivery Method on Breastfeeding Initiation from the The Ontario Mother and Infant Study (TOMIS) III

OBJECTIVE To report on the relationship between delivery method (cesarean vs. vaginal) and type (planned vs. unplanned) and breastfeeding initiation in hospital and continuation to 6 weeks postpartum as self-reported by study participants. DESIGN Quantitative sequential mixed methods design. SETTING Women were recruited from 11 hospital sites in Ontario, Canada. PARTICIPANTS Participants included 2,560 women age 16 years or older who delivered live, full-term, singleton infants. METHODS Data were collected from an in-hospital questionnaire, hospital records, and a 6-week postpartum interview. RESULTS Ninety-two percent of women reported initiating breastfeeding, and 74% continued to 6 weeks. The method of delivery, when defined as cesarean versus vaginal, was not a determining factor in breastfeeding initiation in hospital or in the early postdischarge period. An unexpected delivery method (i.e., unplanned cesarean or instrument-assisted vaginal deliveries) was associated, at a statistically significant level, with an increased likelihood of initiating breastfeeding and continuation to 6 weeks postdischarge. CONCLUSION Breastfeeding can be considered a coping strategy that serves to normalize an abnormal experience and allows the individual to once again assume control. These unexpected results warrant further investigation to understand why women make the decision to initiate breastfeeding, why they choose to continue breastfeeding, and how they can be supported to achieve exclusive breastfeeding as recommended for infants in the first 6 months.

Healthy Foundations Study: a randomised controlled trial to evaluate biological embedding of early-life experiences

Introduction Adverse early experiences are associated with long-lasting disruptions in physiology, development and health. These experiences may be ‘biologically embedded’ into molecular and genomic systems that determine later expressions of vulnerability. Most studies to date have not examined whether preventive interventions can potentially reverse biological embedding. The Nurse-Family Partnership (NFP) is an evidence-based intervention with demonstrated efficacy in improving prenatal health, parenting and child functioning. The Healthy Foundations Study is an innovative birth cohort which will evaluate the impact of the NFP on biological outcomes of mothers and their infants. Methods and analysis Starting in 2013, up to 400 pregnant mothers and their newborns were recruited from the British Columbia Healthy Connections Project—a randomised controlled trial of the NFP, and will be followed to child aged 2 years. Women were recruited prior to 28 weeks’ gestation and then individually randomised to receive existing services (comparison group) or NFP plus existing services (intervention group). Hair samples are collected from mothers at baseline and 2 months post partum to measure physiological stress. Saliva samples are collected from infants during all visits for analyses of stress and immune function. Buccal swabs are collected from infants at 2 and 24 months to assess DNA methylation. Biological samples will be related to child outcome measures at age 2 years. Ethics and dissemination The study received ethical approval from seven research ethics boards. Findings from this study will be shared broadly with the research community through peer-reviewed publications, and conference presentations, as well as seminars with our policy partners and relevant healthcare providers. The outcomes of this study will provide all stakeholders with important information regarding how early adversity may lead to health and behavioural disparities and how these may be altered through early interventions. Trial registration number NCT01672060; Pre-results.