Karen Wambach

Breastfeeding intention and outcome: A test of the theory of planned behavior

Causal modeling was used to test the hypotheses of the theory of planned behavior for the prediction of prenatal breastfeeding intentions and postpartum breastfeeding outcomes with 135 childbearing women. In support of the theory, prenatal breastfeeding attitudes and perceived behavioral control predicted breastfeeding intentions (R2 = 23); however, the subjective norm variable failed to meet statistical criteria for model entry. Breastfeeding intentions weakly predicted duration of breastfeeding up to 6 weeks postpartum (R2 = .04). No additional empirically suggested prenatal and postpartum variables increased the explanatory power of the model in predicting breastfeeding intentions and duration. Implications for practice and research are discussed.

Clinical lactation practice: 20 years of evidence

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue.

Maternal Fatigue in Breastfeeding Primiparae During the First Nine Weeks Postpartum

This pilot study documented maternal fatigue levels and patterns among breastfeeding primiparae; relationships between maternal fatigue and select physiological, psychological, situational, and performance factors; and fatigue interference with activities of daily living. A convenience sample of 41 mothers completed self-report instruments measuring breastfeeding experiences, fatigue, sleep characteristics, perceived stress, depression, and infant temperament at 3 days, 3, 6, and 9 weeks postpartum. Positive moderate relationships were detected at all four times for: breastfeeding problem severity (r=.38-.66, p<.05), depression (r=.45-.7l,p<.O1), and perceived stress (r=.36-.70,p<.05). Maternal sleep disturbance (r=.40-.54,p<.05) and/or effectiveness (r=-.33--.45,p<.05) correlated with fatigue at each time period. Infant difficulty was positively and mildly related to fatigue at 6 and 9 weeks (r=.32-.43, p<.05). Maternal age correlated positively and moderately to fatigue (r =.31-.50,p<.05). Finally, the impact of fatigue on activities of daily living and maternal role activities was low and nonsignificant. Results suggest fatigue is moderately significant to breastfeeding primiparae in the early to late postpartum period.

A Randomized Controlled Trial of Breastfeeding Support and Education for Adolescent Mothers

Despite substantial evidence of maternal and infant benefits of breastfeeding, adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter durations when compared to their adult counterparts. A randomized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant—peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers. Study participants ( N = 289) enrolled from multiple prenatal clinic and school settings, were 15 to 18 years old, and predominately African American, single, and primiparous. The intervention, which started in the second trimester of pregnancy and extended through 4 weeks postpartum, positively influenced breastfeeding duration (p < .001) within the experimental group, but not breastfeeding initiation or exclusive breastfeeding rates. This education/support intervention was partially effective in enhancing breastfeeding outcomes. Implications for research and practice are described.

Lactation Mastitis: A Descriptive Study of the Experience

This descriptive study of 31 women diagnosed with lactation mastitis in the midwestern United States investigated mastitis symptomatology, self-care and treatment, burden of mastitis, and symptom recurrence and complications. Data collected via telephone interviews soon after diagnosis and daily through the seventh day after symptom onset documented that symptom intensity was moderate, peaked on the second day, and lasted on average 3 to 4 days. Symptoms had greater impact on activities of daily living than on breastfeeding. Sources of advice for self-care included lactation consultants, nurses, nurse practitioners, physicians, family, and friends. Continued breastfeeding was the most frequently used of several self-care practices and was rated as highly effective. Follow-up at 2 and 6 weeks established mastitis recurrence as the most common complication. Breastfeeding women need specific information about mastitis causes, symptoms, and self-care strategies to help prevent and treat the condition. J Hum Lact. 19(1):24-34. Mastitis durante la lactancia: Estudio descriptivo basado en la experiencia Este estudio descriptivo de 31 mujeres con diagnóstico de mastitis durante la lactancia en el Mediooeste de Estados Unidos investigó la sintomatología de la mastitis, el auto-cuidado y el tratamiento, el agobio de la mastitis, síntomas de recurrencia y complicaciones. Los datos que se acumularon por medio de entrevistas telefónicas después del diagnóstico y diariamente durante 7 días después del diagnóstico mostraron que la intensidad de los síntomas era moderada, con un máximo al segundo día, y duraron en promedio de 3 a 4 días. Los síntomas tuvieron un impacto mayor en las acividades diarias que en la lactancia. Las mujeres recibieron apoyo para el auto-cuidado de consultoras de lactancia, enfermeras, médicos, familiares y amigo/as. La medida de auto-cuidado mas frecuentemente usada fue continuar con la lactancia considerada como altamente efectiva. En el seguimiento a las 2 y 6 semanas se encontró que la complicación mas común fue la mastitis recurrente. Las mujeres durante la lactancia necesitan información específica sobre la mastitis, las causas, los síntomas y estrategias de auto-cuidado para ayudar a prevenir y tratar esta condición.

Patient Satisfaction With an Early Discharge Home Visit Program

In 1995, to meet the needs of mothers and newborns discharged early, a home care follow-up program using an advanced practice nurse was initiated at a Midwest academic medical center. Information about the program and elements of patient satisfaction, as measured from program inception, are presented in this article. The major correlates of satisfaction were nurse friendliness, technical skills, infant care teaching, and individualized care. Attending to these areas can facilitate existing program improvement and new program development.In 1995, to meet the needs of mothers and newborns discharged early, a home care follow-up program using an advanced practice nurse was initiated at a Midwest academic medical center. Information about the program and elements of patient satisfaction, as measured from program inception, are presented in this article. The major correlates of satisfaction were nurse friendliness, technical skills, infant care teaching, and individualized care. Attending to these areas can facilitate existing program improvement and new program development.

A Pilot Study of Home-Based Videoconferencing for Breastfeeding Support

Background: Research on using videoconferencing for breastfeeding support is limited. Purpose: Although European case reports have described videoconferencing for providing lactation support, this was the first study to assess the reliability and feasibility of home videoconferencing for breastfeeding assessment and support in the United States. Method: The study used 4 real-time, secure videoconferencing sessions to deliver lactation support to 10 mothers in the home. To assess interrater reliability, percentage agreement was calculated on LATCH assessment scores from telehealth and home-visit International Board Certified Lactation Consultants (IBCLCs) during the first 2 visits. Participants’ perceptions of satisfaction and the overall experiences were documented. Results: The percentage agreement on the 5 LATCH score dimensions ranged between 40% to 100% during the first visit and 80% to 100% during the second visit. To assess feasibility, participants reported their satisfaction with the technology and their perceptions of the videoconference consultation. All participants “strongly agreed” that they were comfortable talking about breastfeeding concerns using home videoconferencing. Conclusion: The findings suggest videoconferencing can potentially be used to support breastfeeding mothers in their homes.

African American Women’s Breastfeeding Experiences: Cultural, Personal, and Political Voices

The low rate of breastfeeding among African American women in the United States is a poorly understood, persistent disparity. Our purpose in this study was to gain an understanding of how African American women experience breastfeeding in the context of their day-to-day lives. The Sequential-Consensual Qualitative Design (SCQD), a 3-stage qualitative methodology aimed at exploring the cultural, personal, and political context of phenomena, was used to explore the experiences of African American women who felt successful with breastfeeding. An integration of qualitative content analysis and Black feminist theory was used to analyze the data. Themes that emerged from Stage-2 data analysis included self-determination, spirituality and breastfeeding, and empowerment. In Stage 3 of the study, participant recommendations regarding breastfeeding promotion and support initiatives for African American breastfeeding were categorized into three themes, including engaging spheres of influence, sparking breastfeeding activism, and addressing images of the sexual breast vs. the nurturing breast.

Beyond Correspondence, Video Conferencing, and Voice Mail: Internet-Based Master's Degree Courses in Nursing

The changing health care system and increasing demands for primary care providers have prompted an increase in nurse practitioner programs in the United States. Nurses in rural areas that are underserved by primary care practitioners often are faced with time and distance barriers to returning to school for advanced education. This article describes Internet-based courses as a unique distance learning platform for preparing primary care nurse practitioners at the University of Kansas (KU) School of Nursing. Discussion includes course development process, matching methods to course content, and other information on promoting interaction between students and faculty.

Exclusive Breastfeeding Experiences among Mexican American Women

Background: According to the Centers for Disease Control and Prevention, Hispanic breastfeeding mothers begin early formula supplementation at higher rates than other ethnic groups, which can lead to shorter breastfeeding duration and decreased exclusive breastfeeding. Acculturation, the process of adopting beliefs and behaviors of another culture, appears to influence breastfeeding practices of Hispanic women in the United States. Little is known about Mexican American mothers’ formula use and exclusive breastfeeding within the context of acculturation. Objective: Our study identified perceived benefits and barriers to exclusive breastfeeding and levels of acculturation among Mexican American women living in a Midwestern city. Methods: We used a qualitative descriptive design integrating Pender’s Health Promotion Model concepts. Individual interviews were conducted in English or Spanish (N = 21). The revised Acculturation Rating Scale for Mexican Americans was used to examine acculturation levels. Results: Acculturation scores indicated that the majority (66%) of the sample was “very Mexican oriented.” Most women exclusively breastfed, with a few using early supplementation for “insufficient milk production.” Three themes emerged: (1) It is natural that a woman give life and also provide the best food for her baby; (2) Breastfeeding is ultimately a woman’s decision but is influenced by tradition, guidance, and encouragement; and (3) Breast milk is superior but life circumstances can challenge one’s ability to breastfeed. Conclusion: Strong familial/cultural traditions supported and normalized breastfeeding. Barriers to exclusive breastfeeding were similar to breastfeeding women in general, in the United States. Findings support the need for culturally competent and individualized lactation care.