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Some women who breastfeed will experience complex ongoing difficulties, such as breastfeeding aversion response (BAR). This recently named breastfeeding challenge is defined as feelings of aversion while breastfeeding for the entire time that the child is latched. This study provides the first prevalence data for the experience of BAR in Australian breastfeeding women. A national online survey investigated the breastfeeding experience of Australian women including data on (1) participant demographics, (2) breastfeeding experience with up to four children, (3) breastfeeding challenges and prevalence of BAR, and (4) the value of available breastfeeding support. This study found that of the Australian breastfeeding women who participated (n = 5511), just over one in five self‐identified as having experienced a BAR (n = 1227, 22.6%). Most reported experiencing some breastfeeding challenges, with only 4.5% (n = 247) having had no breastfeeding complications. Importantly, despite these difficulties, 86.9% of the total women in this study rated their overall breastfeeding experience as good (n = 2052, 37.6%), or very good (n = 2690, 49.3%), and 82.5% of those who experience BAR as good (n = 471, 38.7%) or very good (n = 533, 43.8%). BAR reporting was decreased in higher education and income groups. Women who are breastfeeding for the first time are more likely to encounter difficulties with breastfeeding such as BAR. Complications with breastfeeding are pervasive, but women who can overcome breastfeeding issues often report a positive overall breastfeeding experience. Key messages: This national survey of 5511 breastfeeding women in Australia found that one in five reported having experienced a breastfeeding aversion response.There is limited evidence to guide stakeholders in supporting women who experience complex breastfeeding challenges such as breastfeeding aversion responses.Breastfeeding challenges are common for those who breastfeed however women who are supported to manage breastfeeding aversion response report a positive overall breastfeeding experience. [ABSTRACT FROM AUTHOR]

Breastfeeding initiation rates in Australia are high but duration rates fall well below the World Health Organization targets. Return to work is a known factor impacting 6 months exclusive breastfeeding and continuation into the infants second year of life. Work related factors can influence a woman's confidence in maintaining breastmilk supply after return to employment and determine whether she meets her personal breastfeeding goals. This cross‐sectional online survey is the first Australian study to explore women's experience of maintaining breastfeeding after return to work, in all work sectors. Results revealed variations across work sectors reflected in worker autonomy and confidence in speaking up about breastfeeding rights. Women who had autonomy or flexibility in planning their workday were more likely to be confident in maintaining breastmilk supply. The main predictors for milk supply confidence and meeting personal breastfeeding goals included having: a suitable place to express milk; confidence in speaking out about rights; a formal return‐to‐work plan; a supportive workplace; and returning to work after the period of exclusive breastfeeding. This study reveals that supportive workplace environments can lead to increased confidence in maintaining milk supply, extending durations of breastfeeding. Women who are confident in their rights to express breastmilk, or breastfeed at work, are more likely to meet their own breastfeeding goals. Education, and awareness raising, on the rights of breastfeeding women in the workplace, is a gender equity imperative that can improve experiences for breastfeeding women, and, increase manager and co‐worker knowledge for creating enabling workplace environments for breastfeeding employees. Key messages: Return to work after the birth of a baby impacts breastfeeding duration and personal goal attainment. Unsupportive employment factors can lead to a loss of confidence in ability to maintain adequate breastmilk supply.Having access to sufficient paid parental leave, a suitable place to express milk, autonomy, or ability to take lactation breaks, a formal return to work plan, and confidence in speaking up about breastfeeding rights, impacts meeting breastfeeding goals.Increasing knowledge and awareness on the rights of breastfeeding workers, and the components of supportive and enabling environments, will improve women's confidence in their ability to maintain adequate breastmilk supply, and meet their breastfeeding goals, after return to work. [ABSTRACT FROM AUTHOR]

While gender equality at work and the gendered parameters of workplace conditions are of interest to feminist researchers, this paper brings together sociological and public health perspectives to interrogate factors impacting women who return to work (RTW) while maintaining breastfeeding. Our inquiry is focused on female‐dominated professions, teaching, nursing, and midwifery, and our findings suggest that breastfeeding obstacles exist even when gender‐inclusive policies appear to support women. Workplaces generate both overt and subtle barriers to breastfeeding, which force many women to stop earlier than they intended or create ongoing worry about maintaining breastmilk supply. Interviews with participants who maintained breastfeeding after RTW generated three overarching themes: women's determination to get back into the workforce, not wanting to "rock the boat", and the difficulty in keeping their "head above water". Despite workplace policies that appeared to support breastfeeding, the workplace catered to a supposedly gender‐neutral worker and policies did not translate into practice. Given the many sacrifices that women make to maintain breastfeeding, the level of workplace apathy was surprising, especially in female dominated professions. Our research foregrounds breastfeeding corporeality, not as excess but as an inevitable and essential feature of workplaces, which needs to be acknowledged and accommodated. [ABSTRACT FROM AUTHOR]

Migrants to Thailand come from low‐income border countries, such as Burma (Myanmar). Generally, migrant women experience difficulties obtaining high‐quality health care due to socioeconomic barriers and conflicts with their practices. The aim of this study was to explore migrant Burmese women's experiences of becoming a mother while living in Thailand and their perceptions of motherhood, family support, and traditional postpartum practices. The study used an ethnographic design. In 2015, data were gathered through individual interviews with 10 migrant Burmese women before and after birth. Interview and field note data were analyzed using thematic analysis. Four themes emerged from the data: (i) the more children, the stronger the family; (ii) finding ways to promote baby's health and growth; (iii) sharing responsibility to fulfill parenting role; and (iv) peer and family support. Becoming a mother was important to the Burmese women interviewed; however, as migrants in Thailand, they had to juggle work and care for young children. Most decided that once their child was school age they would be sent to Burma to live with relatives. They engaged in a range of traditional practices to support their infant's health and well‐being and protect their baby from evil spirits. Support from family, and the ability to participate in postpartum practices, were important for Burmese migrant women becoming mothers in Thailand. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding for the first 6 months of life offers the recommended best start in the life for a newborn baby. Yet, in Australia only a small number of babies receive breast milk exclusively for the first 6 months. Reasons for the introduction of formula milk are multi‐factorial including access to appropriate support and the woman's experience of breastfeeding. The language and practices of health professionals can impact upon how a woman feels about breastfeeding and her breastfeeding body. One aspect of breastfeeding support that has had scarce attention in the literature is the language used by health professionals to describe the behaviour of the breastfeeding infant during the early establishment phase of breastfeeding. This paper reveals some of the ways in which midwives, lactation consultants and breastfeeding women describe the newborn baby during the first week after birth. The study was conducted at two maternity units in New South Wales. Interactions between midwives and breastfeeding women were observed and audio recorded on the post‐natal ward and in women's homes, in the first week after birth. The transcribed data were analysed using discourse analysis searching for recurring words, themes and metaphors used in descriptions of the breastfeeding baby. Repeated negative references to infant personality and unfavourable interpretations of infant behaviour influenced how women perceived their infant. The findings revealed that positive language and interpretations of infant breastfeeding behaviour emerged from more relationship‐based communication. [ABSTRACT FROM AUTHOR]

Internationally, women give mixed reports regarding professional support during the early establishment of breastfeeding. Little is known about the components of midwifery language and the support practices, which assist or interfere with the early establishment of breastfeeding. In this study, critical discourse analysis has been used to describe the language and practices used by midwives when supporting breastfeeding women during the first week after birth. Participant observation at two geographically distant Australian health care settings facilitated the collection of 85 observed audio-recorded dyadic interactions between breastfeeding women and midwives during 2008-2009. Additionally, 23 interviews with women post discharge, 11 interviews with midwives and four focus groups (40 midwives) have also been analysed. Analysis revealed three discourses shaping the beliefs and practices of participating midwives. In the dominant discourse, labelled 'Mining for Liquid Gold', midwives held great reverence for breast milk as 'liquid gold' and prioritised breastfeeding as the mechanism for transfer of this superior nutrition. In the second discourse, labelled 'Not Rocket Science', midwives constructed breastfeeding as 'natural' or 'easy' and something which all women could do if sufficiently committed. The least well-represented discourse constructed breastfeeding as a relationship between mother and infant. In this minority discourse, women were considered to be knowledgeable about their needs and those of their infant. The language and practices of midwives in this approach facilitated communication and built confidence. These study findings suggest the need for models of midwifery care, which facilitate relationship building between mother and infant and mother and midwife. [ABSTRACT FROM AUTHOR]

Despite considerable evidence and effort, breastfeeding duration rates in resource-rich countries such as Australia remain below World Health Organization recommendations. The literature on the experience of breastfeeding indicates that women construct and experience breastfeeding differently depending upon their own personal circumstances and the culture within which they live. Breastfeeding has also been described as a deeply personal experience, which can be associated with ‘moral’ decision-making. The aim of this synthesis was to better understand the social phenomenon of breastfeeding by making the hidden obvious. Using a meta-ethnographic approach, we analysed the findings from 17 qualitative studies exploring women's experience of breastfeeding. Commonly used metaphors, ideas and phrases across the national and international qualitative studies were identified. Two overarching themes emerged. Breastfeeding was described in terms of ‘expectation’ and ‘reality’, while the emotional aspects of breastfeeding were expressed in ‘connected’ or ‘disconnected’ terms. The prevalence of health professionals and public health discourses in the language women use to describe their experience, and the subsequent impact of this on maternal confidence and self-assessment of breastfeeding are discussed. This synthesis provides insight into some of the subtle ways health professionals can build maternal confidence and improve the experience of early mothering. [ABSTRACT FROM AUTHOR]

In this month's issue of Colorectal Disease, Boyle et al [1] report on the impact of COVID-19 on colorectal cancer care during the first wave of the pandemic and highlight the key lessons learnt by institutions in the United Kingdom (UK). The impact of the first peak of the COVID-19 pandemic on colorectal cancer services in England and Wales: A national survey, by Boyle et al In the short term this was necessary to divert staff to manage COVID-19 patients in the pandemic but in the medium and longer term, this unwanted side effect has led to untold harm amongst these patients. [Extracted from the article]

This trial randomised and analysed the parastomal hernia (PSH) and complication rates of 201 patients undergoing an end colostomy. In this month's issue of Colorectal Disease, Correa-Marinez et al. report on the secondary end points of the Stoma-Const randomized controlled trial [1]. Stoma-related complications: A report from the Stoma-Const randomized controlled trial, Correa-Marinez et al. [Extracted from the article]

The article presents a case study of a 32-year-old woman with two similar episodes of acute right iliac fossa pain for four period. It discusses the results of her clinical examination, routine blood tests, ultrasound scan and histopathological examination. The patient was diagnosed with appendiceal duplication with benign mucinous cyst of the second rudimentary appendix.

Aim: Anal cancer incidence and mortality rates are rising in the United Kingdom (UK). Surgery is an important treatment modality for persistent or recurrent disease. There is a paucity of data on outcomes for patients undergoing pelvic exenteration for anal squamous cell carcinoma (SCC) for persistent or recurrent disease. The aim of this study was to investigate the outcomes for patients who were treated with pelvic exenteration for anal SCC from two high‐volume, high‐complexity pelvic exenteration units in the UK. Method: A retrospective review of prospectively maintained databases from 2011 to 2020 was undertaken. Primary endpoints included R0 resection rates, overall and disease‐free survival at 2 and 5 years. Results: From 2011 to 2020, 35 patients with anal SCC were selected for exenteration. An R0 resection was achieved in 26 patients (77%). Of the remaining patients, seven patients had an R1 resection and one had a R2 resection. One further patient was excluded from additional analysis as the disease was inoperable at the time of laparotomy. With a median follow‐up of 19.5 months (interquartile range 7.9–53.5 months), overall survival was 50% (17/34). Patients with an R1/2 resection had a significantly poorer overall survival [0.27 (0.09–0.76), p = 0.021] than those patients in whom R0 resection was achieved. Disease‐free survival was 38.2% (13/34) and an R1/R2 resection was associated with a significantly reduced disease‐free survival [0.12 (0.04–0.36), p < 0.001]. Conclusion: Complete R0 resection for recurrent or persistent anal SCC is possible in the majority of patients and improves overall and disease‐free survival compared with R1/R2 resection. [ABSTRACT FROM AUTHOR]

Video S1 also describes our preferred flap reconstruction technique using a (left) superior gluteal artery perforator flap, with the bulk of the flap being used to fill the pelvis and skin to reconstruct the vagina. High-resolution MRI has the highest accuracy for staging of rectal cancer and assessing the lateral pelvic side wall lymph nodes and disease extent [4]. Video S1 demonstrates the technique of open pelvic sidewall excision and gluteal flap perineal reconstruction in a female patient with recurrent rectal cancer following long-course chemoradiotherapy. [Extracted from the article]

Abstract: Purpose: This article explores the development and evaluation of a smartphone mobile software application (app) to collect qualitative data. The app was specifically designed to capture real‐time qualitative data from women planning a vaginal birth after caesarean delivery. This article outlines the design and development of the app to include funding, ethics, and the recruitment of an app developer, as well as the evaluation of using the app by seven participants. Organizing Construct: Data collection methods used in qualitative research include interviews and focus groups (either online, face‐to‐face, or by phone), participant diaries, or observations of interactions. This article identifies an alternative data collection methodology using a smartphone app to collect real‐time data. Conclusions: The app provides real‐time data and instant access to data alongside the ability to access participants from a variety of locations. This allows the researcher to gain insight into the experiences of participants through audio or video recordings in longitudinal studies without the need for constant interactions or interviews with participants. Clinical Relevance: Using smartphone applications can allow researchers to access participants who are traditionally hard to reach and access their data in real time. Evaluating these apps before use in research is invaluable. [ABSTRACT FROM AUTHOR]

The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) services have been particularly affected by the Covid‐19 pandemic. Delays in referral to secondary care and access to investigations and surgery have been exacerbated. Aims: To investigate the use of and outcomes for emergency IBD care during the Covid‐19 pandemic. Methods: Nationwide observational study using administrative data for England (2015‐2020) comparing cohorts admitted from 1 January 2015, to 31 January 2020 (pre‐pandemic) and from 1 February 2020, to 31 January 2021 (pandemic). Autoregressive integrated moving average forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 to January 2021. Results: Large decreases in attendances to hospital for emergency treatment were observed for both acute ulcerative colitis (UC, 16.4%) and acute Crohn's disease (CD, 8.7%). The prevalence of concomitant Covid‐19 during the same episode was low [391/16 494 (2.4%) and 349/15 613 (2.2%), respectively]. No significant difference in 30‐day mortality was observed. A shorter median length of stay by 1 day for acute IBD admissions was observed (P < 0.0001). A higher rate of emergency readmission within 28 days for acute UC was observed (14.1% vs 13.4%, P = 0.012). All IBD procedures and investigations showed decreases in volume from February 2020 to January 2021 compared with counterfactual estimates. The largest absolute deficit was in endoscopy (17 544 fewer procedures, 35.2% reduction). Conclusion: There is likely a significant burden of untreated IBD in the community. Patients with IBD may experience clinical harm or protracted decreases in quality of life if care is not prioritised. [ABSTRACT FROM AUTHOR]

Aim: Empty pelvis syndrome is a major contributor to morbidity following pelvic exenteration. Several techniques for filling the pelvis have been proposed; however, there is no consensus on the best approach. We evaluated and compared the complications associated with each reconstruction technique with the aim of determining which is associated with the lowest incidence of complications related to the empty pelvis. Method: The systematic review protocol was prospectively registered with PROSPERO (CRD42021239307). PRISMA-P guidelines were used to present the literature. PubMed and MEDLINE were systematically searched up to 1 February 2021. A dataset containing predetermined primary and secondary outcomes was extracted. Results: Eighteen studies fulfilled our criteria; these included 375 patients with mainly rectal and gynaecological cancer. Only three studies had a follow-up greater than 2 years. Six surgical interventions were identified. Mesh reconstruction and breast prosthesis were associated with low rates of small bowel obstruction (SBO), entero-cutaneous fistulas and perineal hernia. Findings for myocutaneous flaps were similar; however, they were associated with high rates of perineal wound complications. Omentoplasty was found to have a high perineal wound infection rate (40%). Obstetric balloons were found to have the highest rates of perineal wound dehiscence and SBO. Silicone expanders effectively kept small bowel out of the pelvis, although rates of pelvic collections remained high (20%). Conclusion: The morbidity associated with an empty pelvis remains considerable. Given the low quality of the evidence with small patient numbers, strong conclusions in favour of a certain technique and comparison of these interventions remains challenging. [ABSTRACT FROM AUTHOR]

Aim: Ileal pouch–anal anastomosis (IPAA), or a 'pouch', allows restoration of intestinal continuity after proctocolectomy for ulcerative colitis or familial adenomatous polyposis. Most patients have a good long‐term outcome after IPAA, but in a significant proportion the functional outcome and quality of life are unsatisfactory. We term this outcome 'the pouch behaving badly'. Managing this, especially one is when unfamiliar with the possible underlying pathologies, is a challenge for both patient and clinician. We aim to outline the clinical approach to the pouch behaving badly, highlighting key aspects of investigation and management. Method: This is a narrative review of the literature covering the investigation and management of postoperative complications and morbidity after IPAA. Results: Management of the pouch behaving badly requires a careful clinical assessment. The patient may present with multiple symptoms and a clear picture of the symptomatology and past history should be constructed before thorough examination and specialist investigation. We divide the pathology that underlies this clinical scenario into surgical, inflammatory, mechanical, functional and dysplastic causes and outline the investigation and management of each one. Conclusion: The pouch behaving badly is a challenging problem for both patient and clinician. A detailed clinical assessment with careful specialist investigation is key to diagnosing the underlying pathology. We stress the importance of patient‐centred care – the aim is to improve quality of life. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging/positron emission tomography provides a roadmap for surgical planning and serves as a predictive biomarker in patients with recurrent gynecological cancers undergoing pelvic exenteration. This is a case of a young woman with a recurrent rectal cancer, post neoadjuvant chemoradiotherapy, who had a total pelvic exenteration and high sacrectomy with wide sidewall excisions (Video S1). Pelvic exenteration involving sacrectomy is a superspecialist procedure requiring multidisciplinary surgical involvement [[1]]. [Extracted from the article]

Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Video S1 demonstrates the use of a gluteal flap for perineal reconstruction following exenterative surgery. [Extracted from the article]