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This study investigates the impact of different feeding methods (direct breastfeeding, expressed milk feeding, formula feeding) on the infant microbiota at 6 weeks of age. A total of 217 healthy infants stool samples were collected from Hong Kong between August 2018 and December 2019. Various microbial taxa, including the genera Enterobacter and Raoultella were identified in the expressed breast milk feeding group. The richness and composition of the major bacterial phyla showed similar abundance between direct breastfeeding and expressed breast milk. These findings suggests that these bacteria may have colonized the milk during expression or could be introduced from other external sources. The mode of breastfeeding did not significantly alter microbiota parameters in the infant gut at 6 weeks. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effect of two strategies of breast pumping –power pumping (PP) vs. routine pumping (RP) over one week in mothers of very low birth weight (VLBW) infants with low milk output to improve breastfeeding rates at discharge. Methods: Mothers with low milk output, defined as inability to express sufficient breastmilk to meet the feeding requirements of their infant on or after post-natal day 14, were randomized to receive power pumping vs. routine pumping - once daily for 7 d coupled with routine lactation support and hand expression 3 hourly in both groups. The primary outcome was exclusive breastfeeding at discharge. Results: There was no difference in the two pumping strategies with respect to exclusive breastfeeding rates [61.1% in PP vs. 50% in RP group; (p = 0.477, RR 1.2; 95% CI 0.76 to 2.17)]. Median milk volume pumped in the individual power pumping session on 7th day of intervention was significantly higher than that in the individual routine pumping session on the 7th day (50 mL vs. 27 mL, p = 0.014). The cumulative median milk volume expressed per individual pumping session over the 7 sessions of power pumping was also higher than that with routine pumping (305 mL vs. 213 mL, p = 0.054). Conclusions: In this pilot trial, expressed milk volume was significantly higher after each individual power pumping session compared to routine pumping. However, the exclusive breastfeeding rates at discharge were similar in the two groups. [ABSTRACT FROM AUTHOR]

The article presents an editorial focuses on the resiliency in breastfeeding during times of change, emphasizing its importance for adapting to environmental shifts. Topics include the role of breastfeeding in fostering resilience, the vulnerability and openness inherent in breastfeeding, and the need for ethical and transparent research to understand the complexities of lactation.

It is well recognized by the general public that breastfeeding expends calories. In our clinical practice, a number of postpartum women with a history of or a current eating disorder (ED) report using breastfeeding and/or pumping breast milk to influence their body shape and weight. This appears to be either a form of weight control behavior or, in some cases, a compensation for perceived overeating or binge eating. Breastfeeding and pumping have not generally been identified as maladaptive weight control behaviors, nor have they been a subject of research to date. We suggest that this practice should be investigated to determine how common it is, its potential role in maintaining EDs or contributing to relapse in the postpartum period, and to better understand other potential harms it may cause to both the mother and infant/child. Public significance: Breastfeeding and pumping may be used as maladaptive methods of weight control by women with EDs. This behavior is under‐recognized in clinical practice and has received little research attention. We argue that maladaptive breastfeeding and pumping warrant further investigation, as the behaviors may play an important role in maintaining an ED or in contributing to relapse during the postpartum period and may also indirectly harm the infant/child. [ABSTRACT FROM AUTHOR]

Background: Globally, 10% of all births are preterm. Access to human milk via manual breast expression is required to reduce the incidence of adverse outcomes related to prematurity. However, there is little evidence to recommend optimum timing to commence breast expression in mothers of preterm infants or the most effective method. Research Aims: (1) To test feasibility of recruitment and compliance to the protocol and (2) to determine influence of using hand expressing and breast massage on milk production, engorgement, mastitis, and breastfeeding status at 3 months. Methods: This study was an exploratory parallel two-group, pilot randomized controlled trial. Mothers of preterm infants at a metropolitan maternity hospital in Queensland Australia (N = 31) were randomized to receive either hand expressing and breast massage within the 1st hr of birth or standard care, hand expressing within 6 hr of birth, to determine the influence on milk production, engorgement, mastitis, and breastfeeding status at 3 months. Results: Feasibility targets were not met; however, valuable learning from this trial uncovered barriers facing midwives in the birth suite to commencing expressing in the 1st hr of birth. There was no difference in occurrence of secondary outcomes, although trends support future study. Conclusions: Overall, unpredictability of preterm birth influenced our ability to recruit participants. Important directions for future study design would benefit from incorporating expressing times up to 6 hr with a replicable breast massage. [ABSTRACT FROM AUTHOR]

Wearable pumps have been designed to improve convenience and maximize flexibility whilst pumping and are reported to benefit lactating health professionals when they return to work [...]

Breastfeeding women who pump their milk report that pumping is time-consuming [...]

Introduction: At our pediatric institution, lactation consultants completed a quality improvement project exploring ways to support the highest-risk parents in the neonatal intensive care unit: Mothers of outborn infants, who are particularly at risk of lactation problems. Method: We created a structured visitation schedule for these families and tested it over 3 months to see if this schedule increased the milk supply of these mothers. Results: The new schedule was not effective in improving the milk supply. Visits in the first two weeks did not affect the milk supply, but results suggest that later visits showed a trend toward increased supply. External factors may have confounded our results. Conclusion: The lactation team was reassured that the care model in use at baseline supported the parents and their milk supply. [ABSTRACT FROM AUTHOR]

Background: Pumping is a common practice in the United States, but it can be uncomfortable and lead to concerns about milk supply. The fit of the flange, or breast shield, used while pumping can contribute to or alleviate these problems. Flanges are available in a wide variety of sizes, and there are inconsistencies in guidance provided by healthcare providers and pump manufacturers for parents choosing a size. There have been no studies comparing different methods of sizing in terms of comfort and milk output., Research Aims: The aim of this research was to examine differences in milk output and comfort using two methods of flange sizing., Method: A within-subject cross-over design with a convenience sample of parents exclusively feeding their own human milk was used to compare comfort and milk yield between using smaller-fit and standard-fit flanges. Participants pumped for 1 week with each set of flanges and recorded milk output and comfort outcome measures. Data were collected on participant demographics, nipple measurements, and flange sizes used., Results: When compared to the newer small-size fitting, participants using the standard fit flanges had significantly less milk output (mean difference = -15.0 g, 95% CI [-25.0, -5.0], d  = -0.51, p  = 0.004) and less comfort (mean difference = -1.2, 95% CI [-1.6, -0.91], d  = -1.23, p  < 0.001)., Conclusion: Flange fitting is a process that should be individualized to the patient and may require a trial of one or more sizes during a pumping session. Smaller sizes determined using this individualized process and starting with nipple tip measurement may be used without compromising milk output or comfort., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Jeanette Mesite Frem is the owner of Babies in Common, a private lactation practice and educational provider, through which she has received payment for courses educating healthcare professionals about flange fitting methods and the Flange FITSTM Guide as described in this manuscript.

Breast pumping practices have scope for improvement. Breast milk weight measurement can be used to evaluate milk flow pattern dynamics during breast pumping. To determine inter-individual differences in milk flow patterns and their practical implications based on high milk flow rate period (HFP) data among Japanese women expressing breast milk using an electric pump. This cross-sectional, observational study analysed data from 19 women (33.0 ± 3.9 years) nursing 1–6-month-old infants and with previous breast milk expression experience. Breast milk was weighed continuously during a 15-min single-breast electric pumping session. The HFP features and flow rate time (≥0.1 g/s) were analysed to determine each individual's milk flow pattern. The total expressed breast milk was 69.8 ± 42.5 g with a maximum individual flow rate of 0.5 ± 0.2 g/s. The breast milk yielded during the HFPs was 43.1 (34.4–81.3) g, accounting for 82.5 % (69.9–89.5 %) of the total expressed breast milk. HFP occurred 0–3 times during the 15-min session. Multiple discrete and continuous milk flow patterns were observed. Among those with discrete HFP, the HFP interval was 221 (68–371) s. Breast milk fat content changes and subjective residual milk measurements implied sufficient milk removal. A strong positive correlation was noted between HFP length and total breast milk expression volume. Individual differences in milk flow patterns were observed among the women using HFP. Milk flow patterns were consistent with previous reports. Milk flow pattern data can be used to guide individualised lactation support. [ABSTRACT FROM AUTHOR]

Background: Mothers of preterm infants born between 26- and 35-weeks' gestation often report challenges with maintaining a pumping schedule and experience perceptions of low milk supply, both of which may contribute to early termination of breastfeeding within the first few weeks. Purpose: The purpose of this study was to assess the relationship between the amount of expressed milk volumes in the first 2 weeks after delivery and infant's continuing to receive mother's milk at hospital discharge. These results were part of a larger study that examined multiple maternal variables that may impact the amount of milk volumes and continuation of breastfeeding in the preterm infant admitted to the NICU. Methods: Mothers of infants (N = 37) in the NICU were recruited for this correlational, longitudinal study. Data was collected at 24–48 hours post-delivery, at 2 weeks, at 4 weeks from mothers participating in the study and from infant chart reviews. Results/Outcomes: Mothers who reported higher expressed milk volumes at 3 days post-delivery had consistently higher volumes of expressed breast milk and a higher percentage of continued breastfeeding at hospital discharge. There was no statistically significant relationship between breastfeeding self-efficacy scores, socio-demographic variables, or pumping frequency and the percentage of infants receiving breast milk at hospital discharge. Overall, 76.4% of the infants enrolled in the study were receiving 100% of their intake with fortified mother's milk at hospital discharge. Discussion/Implications for Practice: The use of a breast pump log in the first 2 weeks to monitor milk volumes may assist in predicting mothers who are at risk of lower milk supply and early discontinuation of breastfeeding. [ABSTRACT FROM AUTHOR]

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Background: Inconsistent information exists regarding indicators of secretory activation in mothers delivering very low birth weight infants. Research aims: To compare time to the onset of secretory activation using three separate indicators. A secondary aim examined the association between indicators of secretory activation and milk production. Methods: Indicators of secretory activation included maternal perception, volume attainment (production of ≥ 20 mL in two consecutive expression sessions) and biomarkers (sodium and lactose) obtained at volume attainment. Milk production was measured on Days 1–7 and then weekly for 6 weeks. Results: In 69 mothers of infants born ≤ 32 weeks' gestation and < 1500 g, we found no correlation in time to secretory activation between indicators. Earlier volume attainment was associated with increased milk production on Days 1–7, 14, 21, and 28 (all p <.007). Participants who exhibited both normal lactose and sodium levels produced more milk on Days 28 and 42 (p =.028 and.011), those with only normal lactose levels produced more on Day 42 (p =.026) and those with only normal sodium levels on Day 28 (p =.036). Earlier secretory activation by volume attainment was associated with increased expression frequency during Days 2–5 (all p <.014) and participants with normal biomarkers expressed more frequently during Days 2–5 (all p <.020). Conclusion: Mothers of very low birth weight infants are at risk for delayed secretory activation, which may decrease their milk production. Frequent expression during the first 5 days postpartum may promote earlier secretory activation. Valid methods of determining secretory activation are necessary to develop interventions promoting earlier secretory activation. [ABSTRACT FROM AUTHOR]

Background: Although mother's own milk decreases prematurity-associated morbidities, mothers of infants born preterm and very low birth weight experience a significantly shorter lactation duration. Little is known regarding factors associated with lactation cessation during the hospitalization of a very low birth weight infant. Research aim: To determine demographic, social, and personal factors associated with lactation cessation by 6-weeks postpartum in mothers delivering very low birth weight infants. Methods: We used a retrospective, longitudinal, two-group comparison design using data from a randomized control study. Mothers of very low birth weight infants (N = 142) were enrolled from a labor and delivery unit associated with a Level 4 neonatal intensive care unit. Demographic, social, and health information was obtained from the medical records. Participants were surveyed regarding lactation goals, experience, and reason(s) for cessation. Results: Participants who did not continue lactating for more than 6 weeks were more likely to be unemployed (p =.019), Medicaid eligible (p =.009), less educated (p <.031), smoke (p =.002), provide less skin-to-skin care (p =.007), and to delay the decision to provide their milk to their infant (p =.007). After Bonferroni adjustment, only minutes of skin-to-skin care remained statistically significant. Insufficient maternal milk production was the most common reason for lactation cessation. Conclusion: While the etiology of lactation cessation is often non-modifiable, strategies aimed at maintaining mother's own milk production, smoking cessation, increasing skin-to-skin care, and promoting an earlier decision to lactate, may prolong lactation duration in this vulnerable population. This RCT was registered (2012-00071) with ClinicalTrials.com on 6/28/2013. [ABSTRACT FROM AUTHOR]

This document evaluates the mobility and comfort perception of a hands-free, in-bra breastmilk collection pump set. The study involved 23 lactating mothers who used the pump set for a 15-minute pumping session. The results showed that the pump set was efficient and effective in emptying the breasts, with good comfort ratings. The mothers found the pump set easy to use and liked the hands-free aspect and mobility. Overall, the study supports the use of wearable pumps to allow for flexibility in combining lactation and career goals. [Extracted from the article]

This document discusses a study comparing the efficacy and comfort of traditional breast pumping methods with a new hands-free, in-bra breastmilk collection pump set. The study found that the new pump set resulted in efficient and effective breast emptying without compromising comfort. Participants rated the new pump set as more comfortable and liked the hands-free aspect. These findings suggest that wearable pumps may help breastfeeding women support lactation while balancing personal and career goals. The study was conducted in accordance with ethical guidelines and informed consent was obtained from all participants. [Extracted from the article]

An editorial is presented on the importance of supporting breastfeeding parents in the workforce and the cultural challenge of balancing career and breastfeeding. It highlights the need for research in areas such as the impact of milk expression on milk microflora, the effectiveness of breastfeeding equipment, and the implementation of workplace policies to facilitate breastfeeding.

Background: Human milk is recommended as the only nutritional source during the first 6 months of life. For preterm infants, the benefits of human milk are even more important and can alleviate the negative influences of preterm birth. Research aim: To describe how Swedish human milk donors experienced the donation process. Method: A prospective mixed methods mail survey was designed. It was sent to human milk donors (N = 72) at two Swedish hospitals. Quantitative data are presented with descriptive statistics and qualitative data were analyzed using qualitative content analysis. Results: The infants were between newborn and 17 weeks of age when the participants started their human milk donations, and the duration of the donation period lasted 1–24 weeks. The overall theme identified was the participants' strong desire to help infants, often expressed as being involved in saving infants' lives. Many participants experienced difficulties getting the information needed to become human milk donors; for others, expressing milk required both time and energy that they could otherwise spend with their own newborn infants. Conclusion: Donating human milk can be experienced as a demanding and strenuous task. Therefore, it is important that women who donate human milk receive the practical help from health care staff that they feel they need. Furthermore, information and knowledge about the possibility of donating human milk, and how important human milk is for preterm and/or sick infants, are important in order to increase the number of women willing to donate human milk. [ABSTRACT FROM AUTHOR]

Introduction: While many studies have investigated the importance of optimizing pumping patterns for milk removal, the influence of breast shield design on milk removal has not been the focus of extensive investigation. This study aimed to determine the effectiveness of breast shields with either a 105° or a 90° flange opening angle on breast drainage and milk volume expressed during pumping.Material and Methods: This study was a cross-over, randomized controlled non-inferiority trial (Registration; NCT03091985). Mothers (n = 49) of breastfeeding infants participated in the study over two study sessions. Participants were randomly assigned to pump both breasts simultaneously for 15 minutes with either the 105° or 90° breast shield in the first session, and the other shield in the second session. Effectiveness (breast drainage) and efficiency (volume expressed) of both breast shields were assessed after 15 minutes of pumping. Intention-to-treat and per protocol analyses were performed to determine if the 105° breast shield was non-inferior to the 90° breast shield for breast drainage and volume expressed. Perceived comfort was assessed via questionnaire.Results: The 105° breast shield was both non-inferior and superior compared to the standard 90° shield for breast drainage (intention-to-treat, 3.87% (0.01-7.72), P = .049) and volume expressed (intention-to-treat, 9.14 mL (1.37-16.91), P=.02). In addition, the 105° shield was rated as feeling more comfortable (P < .001) and as having an improved fit to the breast (P < .001) compared to the 90° shield.Conclusions: Expressing with the 105° breast shield was more efficient, effective and comfortable compared to the 90° shield. Breast shield design can significantly impact pumping outcomes, and an opening angle of 105° improves both the dynamics and comfort of milk removal. [ABSTRACT FROM AUTHOR]

Background: During pumping, storage, and pasteurization human milk is exposed to light, which could affect the concentrations of light-sensitive vitamins. Currently, milk banks do not regulate light exposure. Research Aim: The aim of this paper was to determine the influence of light exposure during pumping, storage, and pasteurization on (1) macronutrients, (2) select water-soluble vitamins, and (3) select fat-soluble vitamins. Methods: All 13 participants donated 4 milk samples each. Each sample underwent 1 of 4 treatments: raw and light protected, raw and light exposed, pasteurized and light protected, and pasteurized and light exposed. Samples were analyzed for macronutrients and Vitamins B1, B2, retinol, γ-tocopherol, α-tocopherol, and β-carotene. Results: β-carotene concentrations were not influenced by light exposure. Vitamin B1 was significantly (p < 0.05) affected by light-exposure (M = 0.23, SD = 0.01mg/L) compared to light-protected (M = 0.27, SD = 0.01mg/L) samples. Vitamin B2 concentrations were reduced (p < 0.05) by light-exposure in raw (M = 62.1, SD = 0.61µg/L) and pasteurized (M = 73.7, SD = 0.72µg/L) samples compared to light-protected raw samples (M = 99.7, SD = 0.66µg/L). No other tested nutrients were affected by light exposure. Conclusions: If milk is exposed to excessive amounts of light, Vitamins B1 and B2 concentrations may degrade below the current Adequate Intake recommendations for infants 0–6 months of age, increasing the risk of insufficient vitamin supply to the exclusively human milk-fed infant. Thus, pumped or processed human milk should be protected from light to preserve milk vitamin concentrations. [ABSTRACT FROM AUTHOR]

Introduction: Childbearing women with primary or secondary Herpes Simplex Virus type 1 infection are at risk of transmitting neonatal herpes infection to their infants; a medical emergency that is associated with high mortality and morbidity. Neonatal herpes infection has been commonly associated with Herpes Simplex Virus type 2, or genital herpes, but can be caused by either subtype and the presentations are indistinguishable. This case describes the course of diagnosis, treatment, and recovery for a mother and infant during a severe maternal and neonatal herpes infection, and how lactation was maintained and breastfeeding re-established. Our children's hospital coordinated its efforts to assist and monitor this breastfeeding family, and they were able to resume breastfeeding soon after discharge. It is our opinion that it is imperative that mothers receive evidence-based lactation care to maintain their breastfeeding relationship during extended hospital stays. Main Issue: An acutely ill infant was admitted to our urban children's hospital with severe neonatal herpes infection for a total of 3 weeks. His mother was severely affected on her breasts and she required a brief hospitalization. The mother's breasts were covered with draining herpetic lesions that required daily dressing changes. However, her lesions were slow to heal, and a wound care consultation was facilitated and her treatment plan was adjusted. We were surprised that she experienced minimal discomfort with pumping and dressing changes. The mother maintained a positive outlook, complied with the plan to express frequently to maintain milk production, and was able to breastfeed again when they both recovered. Management: This mother received immediate support and appropriate pumping equipment from our hospital personnel and was subsequently able to establish and maintain her milk supply. The difficulty in this case was the management of the mother's extensive herpetic wounds that were slow to heal. A certified wound care specialist was required. Both mother and child recovered from their infections and were able to restart breastfeeding; eventually reaching their goal of breastfeeding for 2 years. Conclusions: Neonatal herpes infection is a potentially fatal disease and maternal child health professionals should have a high suspicion for any ill-appearing newborn with or without a rash. When a breastfeeding infant and mother become infected with Herpes Simplex Virus type 1, it is the responsibility of the healthcare institution to support lactation and the return to breastfeeding rather than recommend cessation of lactation, which is rarely necessary. A multi-disciplinary evidence-based approach to lactation care is essential to preserve lactation during infant hospitalization. [ABSTRACT FROM AUTHOR]

Background: Human milk is understood to be the optimal nutrition for infants, yet many women struggle to nurse. Although exclusively pumping human milk can provide a solution, women may be unaware of this possibility and, thus, experience unnecessary frustration. Research aim: This study aimed to (a) determine the proportion of respondents who had heard of exclusive pumping prenatally; (b) describe sources that respondents turned to and/or received breastfeeding-related information from prenatally; (c) explore the ways in which respondents learned prenatally about exclusive pumping; (d) describe how useful respondents found various information sources when learning about exclusive pumping; and (e) describe the differences between respondents who first heard the term exclusive pumping prenatally versus postpartum. Methods: A cross-sectional, self-report, mixed-methods survey was administered online to a convenience sample of current and/or past exclusive pumpers (N = 1,215). Descriptive statistics were produced (Research aims 1–4), and chi-square tests (Research aims 1, 2, and 5) and a Mann–Whitney U test (Research aim 5) were conducted, to identify trends and compare respondents. Results: Seventy-one percent (n = 864) of respondents had not heard of exclusive pumping until after giving birth. Respondents reported that very few prenatal breastfeeding information sources mentioned or explained exclusive pumping. Women who had heard about exclusive pumping prior to giving birth (n = 291, 24%) reported feeling more knowledgeable about how to exclusively pump and less frustrated, insecure, depressed, rejected, embarrassed, envious, burdened, guilty, and disappointed while exclusively pumping. Conclusion: For postpartum knowledge and affective outcomes to improve, prenatal infant feeding information and education must include information about exclusive pumping. [ABSTRACT FROM AUTHOR]

Objective: While much is known about breastfeeding and postpartum depression, little is known about breast milk pumping's impact on postpartum depression among mothers with infants in the neonatal intensive care unit (NICU). Methods: Thirty-two mothers of infants admitted to a Level III NICU between February and July 2017 were screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). They were also surveyed for current breastmilk pumping activities and demographic factors. Multivariable logistic regression was used to assess the associations between postpartum depression and breast milk pumping, adjusting for confounding variables. Results: After controlling for confounding variables, mothers who did not pump breast milk (relative to mothers who did) were 11 times more likely to have lower EPDS depression scores indicative of probable postpartum depression (OR = 11.7, p-value.05). Conclusions: Our results suggest a significant reduction in probable postpartum depression among NICU mothers who express breastmilk. [ABSTRACT FROM AUTHOR]

Background: The benefits of breastfeeding are well established, and breastfeeding is now widely practiced in the United States. Although increasing numbers of women with physical disabilities are having children, little information is available about breastfeeding practices among these women. Nonetheless, the children of women with physical disabilities should benefit from breastfeeding just as children of nondisabled mothers do. Research aim: This study aimed to explore the facilitators and barriers to breastfeeding among women with physical disabilities. Methods: This study involved semistructured telephone interviews with a convenience sample of women (N = 25) with diverse physical disabilities from across the United States. All participants had given birth within the past 10 years. Interviews were audio-recorded, professionally transcribed, and analyzed using content analysis. Results: Analyses found four broad themes indicating facilitators to breastfeeding: (a) adaptations and equipment, (b) use of breast pump, (c) physical assistance from others, and (d) peer support. We also found five broad themes suggesting barriers to breastfeeding: (a) lack of supports, (b) disability-related health considerations, (c) limited information, (d) difficulties with milk production, and (e) difficulties latching. Conclusion: The need for greater supports for women with physical disabilities who desire to breastfeed as well as information for women and their clinicians about facilitating breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Women are increasingly faced with decisions about how to combine breastfeeding with work, but few researchers have directly measured how breastfeeding relates to the work–life interface. Research aim: The authors examined how perceptions of work enhancement of personal life and work interference with personal life were influenced by workplace breastfeeding support, including organizational, manager, and coworker support, as well as adequate time to express human milk. Then, we examined how workplace breastfeeding support predicted work–life variables and job satisfaction. Methods: Using a self-report, survey design, the authors analyzed online surveys from 87 women in a rural, community sample who indicated that they had pumped at work or anticipated needing to pump in the future. Results: According to regression results, provision of workplace breastfeeding support, particularly providing adequate time for human milk expression, predicted work enhancement of personal life. Conversely, we found that as workplace support diminished, employees perceived greater work interference with personal life. Results of path analysis further suggested that providing time for expressing milk improved job satisfaction via a partially mediated relationship where work enhancement of personal life acted as a mediator. Conclusion: These results suggest that employers can enhance the lives of their breastfeeding employees both at work and at home by providing workplace breastfeeding support, especially through providing time for expressing human milk in the workplace. [ABSTRACT FROM AUTHOR]

A review of the article “Validation of a Theory of Planned Behavior-Based Questionnaire to Examine Factors Associated With Milk Expression" by Y. K. Bai & L. M. Dinour is presented.

Background: Primiparous women are at risk for early, unintended breastfeeding reduction and cessation. Breastfeeding patterns that contribute to these outcomes require further exploration. Research aim: This study aimed to describe early, “real-time” breastfeeding behaviors and perceived problems of primiparous women. Methods: First-time mothers intending to exclusively breastfeed downloaded a commercial infant-feeding app during their postpartum hospitalization. Women logged feedings and their breastfeeding experiences, as they occurred, through 8 weeks postpartum. Additional feeding and background data were collected via electronic medical records and questionnaires administered at enrollment and 2 and 8 weeks postpartum. Summary statistics were compiled to examine weekly breastfeeding behaviors and problems. Results: In this sample of 61 primarily highly educated, White women committed to breastfeeding, 38% (n = 23) used formula during the postpartum hospitalization and 68% (n = 34) used formula at least once by 2 weeks. Nine women stopped breastfeeding during the study. Women using any formula in the hospital and those with less positive baseline attitudes toward breastfeeding were less likely to be exclusively breastfeeding at 2 and 8 weeks, respectively (p < .05). There was a trend toward declining at-breast feeds and high rates of milk expression during the study. Breastfeeding problems peaked at Week 2, with 81% of women (n = 39) endorsing at least one problem at that time. The most prevalent problems included perception of inadequate milk, pain, latching, and inefficient feeds. Conclusion: Interventions to address suboptimal breastfeeding in primiparous women should consider the pervasiveness of early milk expression and in-hospital formula supplementation in this population, as well as the trajectory of common problems. [ABSTRACT FROM AUTHOR]

Introduction: The benefits of mothers own milk on premature and ill infants' nutritional, immunological, and developmental needs have been shown. This article aims to provide insights regarding pumping practices and characteristics of mothers with preterm babies in the neonatal intensive care unit (NICU). Methods: Data on the milk production of women who gave birth to preterm babies at a tertiary teaching hospital was collected between 2010 and 2013. Mothers logged their pumping sessions, and milk was brought to the NICU in accordance with hospital policies. Results: Eighty-one mothers were enrolled in the study. Thirteen (16%) who did not return any logs were excluded from the data analysis. Of the remaining 68 mothers, 16 (24%) began pumping within 6 hours of the birth, whereas 52 (77%) did not. On Day 1, the average daily volume of breast milk pumped was 6 ml (SD = 10, range 0–63 ml). By Day 5, the average daily volume pumped increased to 285 ml (SD = 221, range 0–823 ml). Conclusion: There is a wide range in milk production for mothers of preterm infants, thus highlighting the need for evidence-based information and continuous encouragement of mothers to provide this valuable resource to the very vulnerable preterm infants. [ABSTRACT FROM AUTHOR]

For mothers with breastfeeding difficulties, pumping can be recommended to help establish milk production. However, pumping may present some barriers to successful breastfeeding. Mothers with milk supply concern may be at higher risk of barriers to successful breastfeeding. No previous studies have described experiences of pumping among mothers with milk supply concern. We conducted 10 focus groups of 56 mothers who had milk supply concern in the first month after birth. A paid, trained facilitator led groups in a semi‐structured approach. Sessions were audiorecorded and transcribed verbatim. The transcripts were coded independently by two investigators and analysed using grounded theory. We identified five themes related to the experience of pumping among mothers with milk supply concern: (1) additional control over breastfeeding from pumping: ‘I would feed and then give him … whatever I could manage to pump to him’. (2) Painful experience: ‘The first time I pumped my boobs hurt so bad’. (3) Pumped volume affected milk supply concern: ‘Pump and there was hardly anything coming out that's when I started to worry’. (4) Pumping interfered with other nurturing activities: ‘While you're pumping, you can't touch the baby’. (5) Frustration from inconsistent provider advice: ‘They told me to pump … and then said, “That's going to cause your milk to increase too much” ’. Mothers had positive and negative experiences with pumping. Clinicians should assess a mother's experience shortly after she initiates pumping, as further management and counselling may be necessary to avoid barriers to successful breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Breast milk expression (breast pumping) has become prevalent as an important dimension of breastfeeding behavior. It is, however, not clear whether increasing breast milk expression contributes to extend the duration of breastfeeding. The objective of the present study was to evaluate the impact of breast milk expression in early postpartum period on breastfeeding duration amongst mothers of healthy term infants.Methods: A prospective cohort study had been conducted from March to June 2010. Mothers who gave birth to healthy, full-term and singleton babies were enrolled at discharge. These women were interviewed at 6 weeks postpartum about their breastfeeding behaviors. According to expressing patterns at 6 week postpartum, women were divided into three groups: direct breastfeeding (group 1), combining direct breastfeeding with expressing (group 2), exclusive expressing (group 3). The investigators followed up the women by telephone thereafter at a bimonthly basis and documented breastfeeding duration. Survival analysis was conducted to explore the association between expressing patterns at 6 weeks postpartum and breastfeeding duration. Associated factors of exclusive expressing at 6 weeks postpartum were characterized by logistic regression analysis.Results: Four hundred one eligible women were enrolled at discharge. Among the 389 women who attended the face-to-face interview at 6 weeks postpartum, 345 women continued breastfeeding. They were divided into 3 groups by their expressing patterns. According to survival analysis, women who exclusively expressed breast milk at 6 months postpartum (group 3) were 1.77 times as likely to stop breastfeeding as those who did not (group 1 and 2) (95% confidence interval: 1.25-2.48; P <0.001). There is, however, no significant difference of breastfeeding duration between group 1 and group 2. Subgroup analysis showed that exclusive expressing women who were exclusively breastfeeding at 6 weeks postpartum had the shortest breastfeeding duration. Mother's high education level, short maternity leave, breast milk expression in hospital and bottle-feeding in hospital were associated factors to exclusive expressing at 6 weeks postpartum.Conclusions: Exclusive expressing in the early postpartum period may not help women to achieve long-term breastfeeding duration, especially in women who were exclusively breastfeeding. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of interpersonal communication regarding the breastfeeding support in the workplace. Topics discussed include the business relationship of employees and employers, the work environment management, and the child care and management. Also mentioned are the employees management and the breastfeeding management.

Background: Mothers who deliver a premature infant often choose to provide milk because it is the "one thing that only the mother can do" to optimize her infant's outcome, helps mothers feel a connection with their infants, and helps relieve the guilt associated with the preterm birth. Objective: The purpose of this study was to describe the meaning of milk for mothers who are providing milk for their very low birth weight (VLBW; < 1500 g) infants hospitalized in the neonatal intensive care unit (NICU). Methods: Using a qualitative descriptive design, in-depth semistructured interviews were conducted with 23 mothers of VLBW infants hospitalized in a level III NICU. Mothers were asked to share their perceptions about what providing milk meant to them. Results: Mothers had faith in the healing properties of their milk and equated providing milk with "giving life" to their infants, mitigating the effects of complications, keeping their infants healthy and stable, and helping themselves address the feelings of failure and guilt associated with the premature birth. Mothers' faith in their milk to achieve these outcomes was a maternal motivator to continue pumping, even for mothers who had not intended to provide milk or who experienced the paradox of disliking pumping but wanting to provide their milk. Conclusion: The experiences of these mothers reflect the importance of acknowledging mothers' faith in the healing properties of their milk as a motivating factor for sustaining lactation while coping with the stress and anxiety inherent during the infant's NICU hospitalization. [ABSTRACT FROM AUTHOR]

There are at this moment laws in the United States and other countries governing how women in the work force are to be treated during pregnancy and following. The issue of breast-feeding at work is not one of the issues that have been clearly dictated in the United States. Breast-feeding and breast-pumping both require work breaks and other accommodations from an employer. Deciding this issue will break new ground for workers not only in the United States but possibly the world. The reason breast-feeding at work has become an issue is twofold. The first is the effect this issue has on the community at large and the second component of the debate lies in its effect on the work force. In other words, "Is breast-feeding something that is a legitimate use of work time or should breast-feeding be limited to the home and elsewhere?" This paper will look at how breast-feeding is viewed culturally in the United States, how it is handled legally worldwide, and how it is similar and dissimilar to smoking. Finally, the implications of the courts' decisions on this issue will be discussed as well as what alternatives could or should be taken. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

A retrospective cohort study of infant-feeding practices at 6 months of age was conducted for 382 breastfed infants in a semirural northern California county. The authors hypothesized that almost exclusive breastfeeding at 6 months would be related to maternal experiences in the hospital. Multiple logistic regression analysis, controlling for maternal age and education, found that almost exclusive breastfeeding at 6 months was positively associated with receiving a telephone number for breastfeeding help from the hospital (odds ratio, 6.45; 95% confidence interval, 1.23-33.9), use of a breast pump in the first 6 months (odds ratio, 2.19; 95% confidence interval, 1.01-4.76), and gestational age (odds ratio, 2.26; 95% confidence interval, 1.08-4.71 for a 4-week age difference), whereas formula supplementation at the hospital had a negative association (odds ratio, 0.27; 95% confidence interval, 0.13-0.56). Making postpartum breastfeeding support easily accessible and offering breast pumps at low or no cost may help to increase exclusive breastfeeding rates in this county. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of providing antenatal education regarding milk expression to the support person (SP) of mothers of preterm infants on time to initial milk expression following delivery and daily volume of expressed mother's own milk. Methods: Sixty-one mothers delivering infants <35 weeks gestation and their SP were randomized to receive antenatal education regarding milk expression or to receive standard care. Time to initiation of milk expression was determined through self-report and verified through the electronic medical records. Expressed milk volume was measured on days 1-7 and weekly for 3 weeks. Results: No difference in time to first expression or expressed milk volume was found between groups. Posthoc analysis suggests those in the antenatal education group were more likely to express without nursing assistance and expressed more frequently during days 1-5. Conclusions: SP antenatal education may be an important step in supporting lactation in mothers of critically ill infants. Further research is needed to determine whether SP education during both the antenatal and early postpartum periods could improve lactation success. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04006509.

Introduction: The Baby-Friendly Hospital Initiative has had a positive impact on breastfeeding initiation; however, posthospital exclusive breastfeeding (EBF) rates remain low. We aimed to analyze thoughts and attitudes toward breastfeeding at the postpartum visit among women who deliver at a Baby-Friendly hospital. Methods: Women ≥14 years who delivered a live-born infant at our center were eligible. Participants completed an infant feeding questionnaire at the postpartum visit recording patient and delivery characteristics, antepartum care and infant feeding details, reasons for breastfeeding discontinuation or formula initiation, workplace environment, and cultural beliefs about breastfeeding. Thematic coding via line-by-line analysis of the free responses was performed using NVivo12 by QSR international. Results: Of 263 participants, 110 responded to the open-ended question. Of these, 53 and 46 were negative-toned and positive-toned, respectively. Negative breastfeeding responses related to the mother addressed the need for more support, low milk supply, pressure to breastfeed and feelings of guilt if unsuccessful, maternal health issues, painful breastfeeding, and high time requirements. Negative breastfeeding responses about the baby included concerns about infant health, latching issues, and disinterest. Positive responses focused on the support system, maternal weight loss, health benefits for baby, and mom-baby bonding. Some women (27) commented specifically on pumping. Negative comments noted that pumping led to less milk production, was time consuming, and was too much work. Positive comments about pumping noted that it is a convenient alternative to breastfeeding. Conclusion: Efforts to improve posthospital EBF rates in accordance with national guidelines must acknowledge the complex experience of breastfeeding mothers.

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 outcomes. This study examined the associations among breastfeeding women's perceptions of breastfeeding support in the workplace (i.e., managerial, organizational, co-worker, time, and physical environment), attitudes toward multiple roles, and workplace outcomes (i.e., affective commitment, job satisfaction, and workplace productivity). Materials and Methods: Survey data from 109 mothers who have or are currently breastfeeding/pumping human milk at their workplace were collected and analyzed. Results: Results indicated significant positive relationships among attitudes toward multiple roles and workplace productivity. In addition, perceptions of breastfeeding support were significantly associated with both affective commitment as well as job satisfaction. Finally, our sample of breastfeeding employees returned to work after having a baby primarily for financial reasons, and do not generally feel very supported in the workplace. Conclusions: Overall, organizations can promote more investment and satisfaction in employees by providing explicit communication about breastfeeding-supportive policies to all employees. These findings underscore the importance of organizational breastfeeding support for mothers as well as their coworkers, which ultimately influences the success of the organization as a whole.

Background: In light of the widespread use of breast milk pumping, or, "pumping," mothers are seeking clear, adequate breast pumping guidelines. We aimed at characterizing the information in web pages that mothers might find online when searching for answers related to breast pumping. Materials and Methods: We used Google to search for answers to 10 questions about pumping that mothers might ask. This search used Boolean search. We screened the first three pages of search results for each computer Google search. Each eligible hit (web pages) was evaluated for accuracy, readability, and credibility of its source. Results: Our search strategy produced 241 hits eligible for analysis. The majority of these contained accurate, readable information and were authored by credible sources. The proportion of eligible hits from questions that had a quantifiable (numeric) answer, (e.g., number of days that refrigerated milk remains safe for consumption) differed significantly ( p  = 0.024) from searches that did not. Search inquiries related to milk supply adequacy produced a disproportionately high number of inaccurate hits. Conclusion: Our findings indicate that accurate and credible information about breast pumping is accessible on the internet. However, practitioners should be aware that inaccurate information is present among mothers' likely hits. Our findings also underscore the fact that there are aspects of breast pumping that do not yet have guidelines available, and that these areas warrant further research. In addition, there is a need for guidelines that reflect the individual nature of the experience of breast pumping.

A woman who did not initiate breastfeeding after the birth of her preterm infant did so 27 days later, after her infant developed necrotizing enterocolitis. Using specific strategies including kangaroo care principles and simultaneous breast pumping to faciliate relactation, the mother was able to provide an adequate supply of breastmilk at the time of her infant's hospital discharge. [ABSTRACT FROM PUBLISHER]

The benefits of breastfeeding and breast milk are well established. Women may intend to exclusively breastfeed their infants, but they often need to provide expressed breast milk upon returning to employment or other activities. Without specialized lactation services, women may turn to health care providers, social media, and Web-based information for support and education. Nurses can support breastfeeding women and help them make informed decisions by providing factual, practical information about breast pumps, expression and storage of breast milk, options for testing breast milk, and available resources., (Copyright © 2019 AWHONN. Published by Elsevier Inc. All rights reserved.)

Background: Given the importance of mother's milk for very low birth weight (VLBW) infants, it would be helpful to know which circumstances are most favorable for milk expression., Objective: This study aimed to estimate the volume of milk obtained by mothers of VLBW infants as a function of proximity to the infant and use of the kangaroo position during the actual expression., Methods: In this prospective cohort study, when the infant was stable and the mother had established a breastfeeding routine, she was given a notebook in which to record the location of expression and the amount of milk expressed for 10 consecutive days. Breast milk expression volumes were recorded and analyzed., Results: Data were collected on 26 mother-VLBW infant dyads and 1642 milk expressions. The first early morning expressions (n = 276, 17%) were conducted at home. Thereafter, 743 (45%) expressions were conducted far from the infant, either in a different room within the hospital or at home, and 623 (38%) were performed in proximity to the infant (beside the incubator, during kangaroo mother care [KMC], after KMC, or during kangaroo father care). The mean milk volume was significantly higher when expression was conducted in proximity to the infant. When only milk expressions conducted in proximity to the infant were considered, volumes obtained during KMC (107.7 mL, 91.8-123.5) and after KMC (117.7 mL, 99.0-136.5) were significantly higher than those obtained beside the incubator (96.9 mL, 79.9-113.9), respectively, P = .0030 and P = .0024., Conclusion: Milk expression conducted in proximity to the infant, particularly during and immediately after KMC, is associated with higher milk volume.

Background: Benefits of using a breast pump are well documented, but pump-related problems and injuries and the associated risk factors have not been reported., Objectives: This study aimed to describe breast pump-related problems and injuries and identify factors associated with these problems and injuries., Methods: Data were from the Infant Feeding Practices Study II; mothers were recruited from a nationally distributed consumer opinion panel. Mothers were asked about breast pump use, problems, and injuries at infant ages 2, 5, and 7 months. Survival analysis was used to identify factors associated with pump-related problems and injuries., Results: The sample included 1844 mothers. About 62% and 15% of mothers reported pump-related problems and injuries, respectively. The most commonly reported problem was that the pump did not extract enough milk and the most commonly reported injury was sore nipples. Using a battery-operated pump and intending to breastfeed less than 12 months were associated with higher risks of pump-related problems and injury. Learning from a friend to use the pump was associated with lower risk of pump-related problems, and using a manual pump and renting a pump were associated with a higher risk of problems., Conclusion: Our results suggest that problems and injuries associated with breast pump use can happen to mothers of all socioeconomic characteristics. Breastfeeding mothers may reduce their risks of problems and injury by not using battery-operated pumps and may reduce breast pump problems by not using manual pumps and by learning breast pump skills from a person rather than following written or video instructions.

This case describes a woman who was unable to position the shields of a breast pump properly onto her breasts. Several thoracic surgeries as well as a spinal fusion contributed to her physical limitations. Using a mirror to watch herself place the breast shields enabled her to pump effectively. [ABSTRACT FROM PUBLISHER]

In 2005, the Level III neonatal intensive care unit (NICU) at Rush University Medical Center initiated a demonstration project employing breastfeeding peer counselors, former parents of NICU infants, as direct lactation care providers who worked collaboratively with the NICU nurses. This article describes the conceptualization, implementation, and evaluation of this program and provides templates for other NICUs that wish to incorporate breastfeeding peer counselors with the goal of providing quality, evidence-based lactation care.