Pamela D. Hill

Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth

This study reports the temporal pattern of milk output in 2 groups of lactating mothers during the first 6 weeks postpartum. A study aim was to examine if the average milk output for postpartum days 6 and 7 (baseline) predicts milk adequacy at week 6 postpartum. Mothers of preterm (= 31 weeks) infants (n = 95) used mechanical expression to initiate and maintain their milk supply; mothers of a singleton healthy term infant (n = 98) fed their infant at the breast. Baseline milk output was predictive of milk adequacy, defined as = 500 mL/d at week 6 (P = .000). Preterm mothers were 2.81 times more at risk of not producing adequately than term mothers were. Study findings suggest that interventions that promote the initiation and maintenance of an adequate milk supply during the first week postbirth are critical.

Breastfeeding and health professional encouragement.

The objective of the study was to ascertain the nature of health professional contacts related to breastfeeding for 341 women. Subjects were prospectively queried by phone or home visit over a 20-week period regarding the number and nature of contacts with health care professionals related to breastfeeding. Lactation consultants gave significantly more positive encouragement (98%) (p=.OI) than either nurses (75%) or physicians (68%) did. However, of the 233 health provider contacts that included breastfeeding advice, only 21% involved lactation consultants. Primiparae were likely to decrease their level of breastfeeding if a health professional encouraged supplemental foods (39%) or weaning (86%) during the prior week. Multiparae who were experienced at breastfeeding (3+ weeks breastfeeding the previous infant) decreased their breastfeeding slowly across the weeks with the current infant, and their level of breastfeeding in general appeared independent of health care provider advice. Multiparae who lacked previous sustained breastfeeding experience (0-3 weeks) had the most rapid decrease (65%) in their breastfeeding rates even with health care provider encouragement to continue. Thus, they too appeared to act independently of health care provider advice.

Effects of pumping style on milk production in mothers of non-nursing preterm infants.

Milk production was examined in 39 lactating mothers of non-nursing preterm infants from 2 tertiary care centers. The purposes of this study were (1) to compare milk production of those using sequential single (SEQ) or simultaneous double (SIM) breast-pumping regimen, and (2) to examine the relationship of selected variables to inadequate (<3500 g/week) and adequate (>3500 g/week) milk production. In multivariate analysis, mothers using SIM produced a similar amount of milk by weight during weeks 2 to 5 postpartum compared to those using SEQ. A logistic regression model including frequency of kangaroo care, frequency of pumping, high versus low income, and previous breastfeeding experience was predictive of mothers producing adequate versus inadequate milk volume 79% of the time. All of the mothers producing >3500 g at week 2 produced adequate amounts of milk at weeks 4 and 5. None of the mothers producing < 1700 g at week 2 reached adequate production by weeks 4 and 5. Of the remaining mothers who produced 1700 g to 3500 g at week 2, 54% achieved adequate production during weeks 4 and 5 postpartum.

Prevention of and Therapies for Nipple Pain: A Systematic Review

OBJECTIVE To review the literature on nipple pain and to delineate effective strategies for the prevention and treatment of nipple pain in breastfeeding mothers. DATA SOURCES Computerized searches on MEDLINE, Pre-MEDLINE, CINAHL, and the Cochrane Library. STUDY SELECTION Articles from indexed journals relevant to the objective were reviewed from January 1983 to April 2004. Preference was given to research-based studies in English. DATA EXTRACTION Data were extracted and organized under two headings: prevention of nipple pain or trauma and treatment of nipple pain or trauma. The Critical Appraisal Form by J. Briggs was used to extract the data from research-based articles. DATA SYNTHESIS The health benefits of breastfeeding for mother and infant are well documented; however, nipple pain is a common reason reported by women for the early termination of breastfeeding. Several studies have compared various treatments for either the prevention of or treatment for nipple pain. These treatments include warm water compresses, tea bag compresses, heat, application of expressed mothers milk, lanolin, vitamin A, collagenase, dexpanthenol, hydrogel therapy, glycerin gel therapy, moist occlusive dressing, education regarding proper latch-on and positioning, and no treatment. CONCLUSIONS No one topical agent showed superior results in the relief of nipple discomfort. The most important factor in decreasing the incidence of nipple pain is the provision of education in relation to proper breastfeeding technique and latch-on as well as anticipatory guidance regarding the high incidence of early postpartum nipple pain.

Development of the H & H Lactation Scale.

Psychometric properties of the H & H Lactation Scale, based on the Insufficient Milk Supply (IMS) conceptual framework, were examined in two separate studies. The two convenience samples consisted of 110 mothers of low-birth-weight (LBW) infants and 120 mothers of healthy term infants. Both groups planned to breastfeed and were actively breastfeeding or pumping to maintain a milk supply. Subscales identified by factor analysis measured three concepts: maternal confidence/commitment to breastfeeding, perceived infant breastfeeding satiety, and maternal-infant breastfeeding satisfaction. All subscales showed moderate to high internal consistency (alphas .75 to .98) as well as concurrent and predictive validity. The total scale and the three subscales were prospectively significantly related to level of breastfeeding 8 weeks after delivery with both groups of mothers.

Does Early Supplementation Affect Long-Term Breastfeeding?

The purpose of this secondary data analysis from two different samples was to examine the effect of early supplementation with manufactured milks on breastfeeding status at 20 weeks postpartum in mothers of healthy term infants. In two convenience samples of 120 and 223, respectively, breastfeeding mothers were followed up for 20 weeks postpartum or until weaning occurred. The breastfeeding rate at 20 weeks postpartum was significantly greater for mothers who reported feeding exclusively mothers milk the second week after delivery compared with mothers who breastfed and simultaneously supplemented with manufactured infant milks. Of the mothers in samples one and two who exclusively fed human milk during week 2 postpartum, 63.0% and 59.7%, respectively, were still breastfeeding at week 20, compared with 28.1 % and 24.2 %, respectively, who supplemented with artificial milks. There was no significant difference between these two groups of mothers and their intended duration of breastfeeding. Early introduction of supplemental bottles of artificial milks is associated with a decrease in the amount of human milk the infant receives as well as with early weaning.

Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants.

This secondary data analysis examined if time of initiation of milk expression and pumping frequency influenced milk weight weeks 2-5 postpartum. Of the 39 subjects in the convenience sample, 20 were in the early initiating (EI) group, (n = 12 high frequency [HF], n = 8 lowfrequency [LF]), and 19 were in the late initiating (LI) group, (n= 7HF, n = 12LF). The EI group initiated pumping = 48 hours after birth; the HF group pumped a minimum of 6.25 times daily. A two-way analysis of variance indicated that milk weight was significantly higher in the HF as compared to the LF group. While there was no significant difference in milk weight between the EI and LI groups, therewas a significant interaction between frequency and initiation. Milk weight for the LF group appeared to be positively influenced by the initiation of mechanical expression soon after birth.

“They’ve Walked in My Shoes”: Mothers of Very Low Birth Weight Infants and Their Experiences With Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit

The effectiveness of the breastfeeding peer counselor role is thought to be embedded in the relationship between new and experienced mothers. In this study, new mothers of very low birth weight infants emphasized that one of the most important aspects of their relationship with the breastfeeding peer counselors is the peer or shared experience of how difficult it can be to provide milk and breastfeed while coping with the emotional stress of having an infant in the neonatal intensive care unit. This study provides evidence for the promotion and facilitation of lactation for mothers of neonatal intensive care unit infants through the use of breastfeeding peer counselors who are peers by virtue of the shared experience of providing milk for an infant hospitalized in the neonatal intensive care unit.

The Parental Experience of Pregnancy After Perinatal Loss

OBJECTIVE To review the research literature on the parental experience of pregnancy, primarily maternal, subsequent to perinatal loss. DATA SOURCES Computerized searches on CINAHL and PubMed databases. STUDY SELECTION Articles from indexed journals relevant to the objective were reviewed from January 1997 to December 2007. Only research-based studies in English were included. DATA EXTRACTION The review was performed using the methodology of Whittemore and Knafl (2005). Data were extracted and organized under headings: author/year/setting; purpose; sample; design/instruments; results; and nursing implications for parents during a pregnancy following a perinatal loss. DATA SYNTHESIS Depression and anxiety are frequently seen in pregnant women subsequent to a perinatal loss. The parental experience is filled with intense and conflicting emotions as parents balance being hopeful while worrying about another potential loss. CONCLUSIONS It is important for health care providers to evaluate the womans obstetric history, acknowledge and validate previous perinatal loss, and discuss with her what would be helpful during the prenatal period with respect to the previous perinatal loss.

Smoking and breastfeeding status.

In women who breastfeed, cigarette smoking is associated with early termination of lactation. The relationship among smoking, demographic variable, and breastfeeding status at 8 weeks postpartum was examined in 400 mothers of term infants and 110 mothers of low-birth-weight (LBW) infants using multivariate analysis. Women who smoked were more apt to stop breastfeeding early in both study samples. In addition, in the term sample, older and married women more frequently reported breastfeeding at 8 weeks than younger, nonmarried women. In the LBW sample, those who were employed were less apt to report breastfeeding at 8 weeks than those who were unemployed. Also, a greater proportion of smokers in both samples indicated insufficient milk as a reason for a decline in breastfeeding compared to nonsmokers. The effects of cigarette smoking should be examined in subsequent studies of breastfeeding patterns.