Sara L. Gill

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.

Effects of support on the initiation and duration of breastfeeding

Researchers attempted to increase the initiation of breastfeeding and its duration to 6 months among a group of low-income, Hispanic women through an intervention program which included prenatal education and home based postpartum support. All participants were telephoned after delivery to determine infant feeding method. Duration of breastfeeding was determined by counting the number of days from initiation to the last day the baby was put to the breast. The Bayesian approach was used for the statistical analyses. In the intervention group, the propensity to initiate breastfeeding exceeded that of the control group. Results indicate the intervention group had twice (2.31) the odds of starting breastfeeding, twice (1.84-3.15) the odds of continuing to breastfeed for 6 months, and only half (.50-.54) the tendency to quit at any one time than did the control group.

Assessing Infant Breastfeeding Beliefs Among Low-Income Mexican Americans

Focus groups were conducted with low-income, pregnant women and new mothers receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) along with their male partners and their mothers. All participants were Hispanics of Mexican American origin. The topics for the focus-group discussions were breastfeeding beliefs and perceptions. All participants were aware of the benefits of breastfeeding. Participants identified time, embarrassment, and pain as barriers to breastfeeding; discussed decision-making efforts regarding breastfeeding; identified cultural beliefs related to breastfeeding; and discussed the lack of care-provider support for breastfeeding.

Predicting breast-feeding attrition: adapting the Breast-feeding Attrition Prediction Tool

ContextCurrent breast-feeding rates fall short of the recommendations set forth in Health People 2010. The Breast-feeding Attrition Prediction Tool (BAPT), administered in the postpartum period, has been useful in predicting breast-feeding attrition. However, assessing a womans intention to breast-feed prior to birth would identify women at risk for breast-feeding attrition. PurposeThe purpose of this study was to describe a revised BAPT, administered antepartally that measures intention to breast-feed. MethodsThe BAPT, comprising 94 items on a 6-point Likert-type scale, was translated into Spanish and back-translated for accuracy. The BAPT was then revised by reducing the number of items to 35 (32 were used for analysis) and contracting the 6-point scale to 3 categories. A Bayesian item response model provided the psychometric properties of the revised BAPT. ResultsThe revised BAPT was completed by 143 Mexican American pregnant women. Items, some reverse scored, were recoded as “agree” versus “disagree.” Item analyses indicated a wide range of item discriminabilities, with most items being useful measures of intention to breast-feed. Person analyses provided scores for intention to breast-feed. A simpler scoring system was devised for applications. ConclusionsThe revised BAPT shows promise as a measure of intention to breast-feed. The scoring system also indicates which women may need additional interventions to promote breast-feeding.

Cost Comparison of Baby Friendly and Non–Baby Friendly Hospitals in the United States

OBJECTIVES: The objectives of this study were to provide an economic assessment of the incremental costs associated with obtaining the World Health Organization and United Nations International Childrens Emergency Fund designation as a Infant-Friendly hospital. We hypothesized that baby-friendly hospitals will have higher costs than similar non–baby-friendly hospitals. METHODS: Data from the 2007 American Hospital Association and the 2007 Centers for Medicare and Medicaid Cost Reports were used to compare labor and delivery costs in baby-friendly and non–baby-friendly hospitals. Operational costs per delivery were calculated using a matched-pairs analysis of a sample of baby-friendly and non–baby-friendly hospitals in the United States. Costs associated with labor-and-delivery diagnosis–related codes were analyzed for each baby-friendly hospital and compared with the mean and median costs incurred by non–baby-friendly hospitals. RESULTS: Nursery plus labor-and-delivery costs for the baby-friendly sites were

Home-based injury prevention practices used by mothers of Mexican descent living in San Antonio, TX

2205 per delivery, compared with

A microcosting study of establishing a baby café® in texas

2170 for the non–baby-friendly matched pair. Baby-friendly facilities have slightly higher costs than non–baby-friendly facilities, ranging from 1.6% to 5%, but these costs were not statistically significant (P > .05). CONCLUSIONS: These results suggest that becoming baby-friendly is relatively cost-neutral for a typical acute care hospital. Although the overall expense of providing baby-friendly hospital nursery services is greater than nursery service costs of non–baby-friendly hospitals, the cost difference was not statistically significant. Additional research is needed to compare the economic impact of maternal and infant health benefits from breastfeeding versus the incremental expenses of becoming a baby-friendly hospital.

“I’m Doing the Best That I Can for Her”: Infant-Feeding Decisions of Mothers Receiving Medication-Assisted Treatment for an Opioid Use Disorder:

PURPOSE To describe the home-based injury prevention practices used by low-income mothers of Mexican descent with their preschool children. DESIGN AND SAMPLE A descriptive qualitative study with convenience sampling of mothers (n=9) who are of Mexican descent and have preschool children. METHOD Data collection consisted of ethnographic interviews supplemented by focused home observations. RESULTS 2 themes emerged from the data: the spectrum of physical proximity and the use of injury prevention technology. The spectrum of physical proximity reflected the degree of physical closeness (i.e., supervising children, watching children closely, and being after children) that the mothers used to manage injury risk in their children. Children who were perceived as curious or restless, or too young were judged by the mothers as being prone to injury and requiring more maternal physical closeness. The participants used the injury prevention technology recommended by the experts despite their limited economic resources. However, this group of mothers used the spectrum of physical proximity as the main tool to prevent child injuries in their home. CONCLUSION These findings provide an insight into the attitudes and behaviors of low-income, Mexican mothers toward injury prevention in the home. Awareness of these attitudes and behaviors will allow for the creation of interventions that take into account this maternal perspective.

Infant Feeding Decisions Among Mothers Who Receive Medication-Assisted Treatment for Opioid Use Disorder

Background: This article focuses on the costs of opening and running a Baby Café. A Baby Café is an intervention that focuses on providing peer-to-peer support for breastfeeding mothers. Research aim: This study aimed to estimate the costs of establishing and running a Baby Café. Methods: The authors used a microcosting approach to identifying costs using the case of a Baby Café located in San Antonio, Texas, and modeled after other existing cafés in the United States. They also used extensive literature review and conducted an informal interview with a manager of an existing Baby Café in the United States to validate our cost data. The cost analysis was done from the provider perspective. Results: Costs of starting a Baby Café were

Understanding Self-regulation Behaviors in South Asians With Coronary Artery Disease: A Mixed-Methods Study

36,000, whereas annual operating costs totaled