Abstract
Exploring Turning Points in the Breastfeeding Experience of New Moms
Ellen Schafer, PhD, MPH, MCHES1, Elana Buch, PhD2, Shelly Campo, PhD3 and Sato Ashida, PhD2
(1)University of South Florida, Tampa, FL, (2)University of Iowa, Iowa City, IA, (3)University of Iowa, College of Public Health, Iowa City, IA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: In Iowa, 82% of babies are ever breastfed. However, many mothers do not maintain breastfeeding for recommended durations: about half are breastfed at 6 months and one-third at 12 months. Understanding mothers' experiences throughout the entire breastfeeding maintenance period will help explain this gap between initiation and maintenance, and inform our interventions.
Objective: Explore contextual factors that may facilitate or deter breastfeeding maintenance by identifying common turning points (significant events or time periods promoting a change in thoughts/behaviors or facilitating maintenance) described by mothers across their varied experiences.
Methods: In qualitative semi-structured interviews, a socioeconomically diverse sample of first-time mothers in Iowa were asked to think back and share their infant feeding experience, from breastfeeding initiation through cessation. Interviews generally lasted 45-60 minutes. Transcripts were coded to identify themes and turning points in the breastfeeding experience.
Results: Twenty-eight mothers were interviewed with a mean breastfeeding duration of 37 weeks (range <1-94 weeks). Seven turning points, consistent across durations, were described: breastfeeding problems, overcoming unknowns, recurring stressors, living life with the new baby, re-entering social roles, special occasions, and letting go. Turning points were usually associated with stressful situations and mothers described intrapersonal (e.g., determination) and interpersonal (e.g., social support) coping resources as facilitators of breastfeeding maintenance.
Conclusion: This study identified turning points during the breastfeeding experience and opportune times for maintenance interventions. Mothers encountered stressors at each turning point and outcomes were described in terms of coping resources. Implications for service delivery and future research will be discussed.
Social and behavioral sciences
Abstract
Express yourself: Barriers and facilitators to pumping in the workplace
Deidre Orriola, MPH, CPH, CLC1, Emily Rizzo, MPH, CLC2, Ivonne Hernandez, PhD, RN, IBCLC1, Taylor Caragan, MPH, CLC3 and Alyssa Fedgo, BS1
(1)University of South Florida, Tampa, FL, (2)Florida Department of Health, Marion county, Ocala, FL, (3)Department of Health in Manatee County, Brandon, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: The Fair Labor Standards Act requires employers to provide break time and space, other than a bathroom, for employees to express breast milk. Although supporting breastfeeding brings value to the workplace, employees still face tremendous barriers to continue breastfeeding upon returning to work after the birth of a child.
Purpose: This assessment was designed to evaluate the extent to which lactation accommodations are provided, recognized, and utilized at two of the largest employers in Hillsborough County, Florida: a tertiary care hospital and a metropolitan research university.
Methods: A total of 324 employed mothers completed a confidential online survey sent through internal mailing lists. Qualtrics Survey Software and SPSS were used for analysis.
Results: While 85% of working mothers planned to exclusively breastfeed, most (54%) did not breastfeed for as long as they wanted. Existing lactation rooms (n = 4) were reported to be inaccessible or inconvenient, and 12% of respondents expressed breast milk in a restroom. Some respondents did not express breast milk at work (24%). Of those, nearly half stopped breastfeeding altogether before returning to work. Common reasons for stopping included lack of time to pump (26%) and inconvenience of pumping (20%). Facilitating factors included encouragement, clear expression of the policy, accessible location, and sufficient time.
Conclusions: Employees would benefit from an expanded workplace policy that provides planning resources and break time. In addition, women need to feel supported by colleagues and supervisors. Increasing dedicated, accessible lactation spaces has the potential to reduce barriers to meeting breastfeeding goals.
Administer health education strategies, interventions and programs Administration, management, leadership Advocacy for health and health education Public health or related laws, regulations, standards, or guidelines Public health or related organizational policy, standards, or other guidelines
Abstract
Improving Human Milk Use for Very Low Birth Weight Infants in Massachusetts: A Collaborative Quality Improvement Approach
Laura Burnham, MPH1, Adriana Lopera2, Munish Gupta, MD, MMSc, FAAP3 and Margaret Parker, MD, MPH1
(1)Boston Medical Center, Boston, MA, (2)Boston University School of Public Health, Boston, MA, (3)Beth Israel Deaconess Medical Center, Boston, MA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background: The Neonatal Quality Improvement (QI) Collaborative of Massachusetts formed a statewide improvement project in January 2015 to improve human milk (HM) use for very low birth weight (VLBW) infants.
goals: To increase the rate of any and exclusive HM use in the 24 hours prior to hospital discharge/transfer among VLBW infants by 20% from January 2015 to December 2017.
methods: In our collaborative, we employ the Institute of Healthcare Improvement Model for Improvement and focus on breastfeeding initiation, continuation, parent education, and transition to post-discharge breastfeeding. We use statistical process control charts to examine measures over time. We provide teams QI education through webinars, in-person conferences, newsletters, and monthly homework assignments. We manage a centralized REDCap database and generate monthly data reports.
results: By December 2015, representing the first year of our collaborative, all 10 level 3 NICUs in MA joined the collaborative and initiated 21 plan-do-study-act cycles (14 initiation, 6 continuation, 1 education). Six hospitals entered data on 385 VLBW infants into REDCap. We found that 67% of VLBW infants received any HM at discharge/transfer and 25% of mothers pumped or hand expressed within 6 hours of delivery; no significant change was observed for either measure. We found that provision of breast milk education during prenatal consultation significantly increased from 56% to 79% per control chart analysis.
conclusions: In our first year, we have had universal participation in our statewide collaborative. In the next 2 years, we anticipate continued improvements in HM use and other process measures.
Diversity and culture
Abstract
Examining the Relationship Between Infant Feeding Practices and Child Hyperactive/Inattentive Behaviours in a Canadian Sample
Sarah Turner, Bachelor of Health Sciences, Nathan C. Nickel, MPH, PhD, Tracie Afifi, PhD, Jennifer Theule, PhD and Marni Brownell, PhD
University of Manitoba, Winnipeg, MB, Canada
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder diagnosed in childhood. It is largely accepted that ADHD is a product of gene-environment interactions and method of infant feeding has been proposed as a factor influencing the expression and/or severity of ADHD. The objectives of this study were to determine the relationship between infant feeding (i.e. formula feeding or breast feeding) and subsequent hyperactive/inattentive (H/I) behaviours and ADHD diagnosis.
This study used data from the 2000/1, 2002/3, 2006/7 and 2008/9 cycles of the National Longitudinal Survey of Children and Youth (NLSCY) to follow children longitudinally from the age of 0 to 1 years old to 6 to 7 years old. Infant feeding at 0 to 1 years old, and child H/I score and ADHD diagnosis at 6 to 7 years old were reported by the biological mother. Multivariable logistic and linear regression were used to determine the relationship between infant feeding and H/I score and ADHD diagnosis adjusting for a range of sociodemographic, birth, and home environment factors.
Breastfeeding for more than 12 months was found to be significantly associated with lower odds of scoring high on the H/I scale in the most adjusted model (OR=0.3; 95% CI 0.2-0.8, p<0.01). Infant feeding was not associated with ADHD diagnosis. Possible reasons for this association are discussed. In Canada, a small proportion of mothers breastfeed beyond one year, however, this study shows that breastfeeding for longer than one year may significantly reduce the odds of hyperactive/inattentive behaviours in today's children.
Epidemiology Planning of health education strategies, interventions, and programs
Abstract
Herbal and pharmaceutical galactagogue use among breastfeeding mothers with low milk supply
Diana Cassar-Uhl, MPH, PhD, IBCLC1 and Penny Liberatos, PhD2
(1)University of Maryland School of Public Health, College Park, MD, (2)New York Medical College School of Health Sciences & Practice, Valhalla, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background:
Use of herbs/medications to increase milk supply (galactagogues) is prevalent among breastfeeding mothers, with rates of 24.3%-28% of women reported in two recent studies, but the effectiveness of these substances has not been extensively studied. This study examines galactagogue use among mothers more likely to use substances due to low milk supply.
Methods:
Mothers with low milk supply were recruited via Internet platforms (blogs, Facebook, discussion forums) and asked to complete an anonymous, online questionnaire between February and December of 2013. Respondents were asked to rate how effective each of 32 galactagogues were in improving their milk production (Likert scale 1-5, where 1=not at all effective, 5=very effective) as well as their breastfeeding experiences.
Results:
Of the 769 women who reported use of galactagogues, 93% tried at least one, and among these an average of 7.6 galactagogues were tried. Fenugreek, oatmeal and breastfeeding teas were used most often but Domperidone, goat's rue, and multi-herb blend were rated most effective. Overall, higher educational attainment was significantly associated with greater galactagogue use. Greater galactagogue use and use of specific galactogogues were significantly associated with BF duration at 2, 4, and 6 months.
Conclusions:
Since use of herbs/medications during breastfeeding is a widely practiced behavior among breastfeeding mothers, especially those with low milk supply, an understanding of characteristics that may be associated with this behavior and the perceived effectiveness of galactagogue use will enable practitioners/health educators who work with new mothers and better counsel them on approaches to increase their milk supply.
Assessment of individual and community needs for health education Implementation of health education strategies, interventions and programs Other professions or practice related to public health Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
American Indian/Alaska Native CHAMPS: A Look at Culturally Relevant Breastfeeding Education
Camie Goldhammer, LICSW, MSW, CLE, IBCLC1, Anne Merewood, PhD, MPH, IBCLC2 and Kirsten Krane, MS-MPH, RDN3
(1)Self employeed, Seattle, WA, (2)Boston Medical Center, Boston, MA, (3)Boston University, Boston, MA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Despite the current national momentum to diversify the field of lactation in the US, little has been done to address education resources for diverse communities of color. White women still dominate the field of lactation when it comes to the creation of breastfeeding training materials and setting standards for current lactation certifications (CLC, CLE, and IBCLC). The result has created a cultural relevance gap when it comes to providing education and support, especially to American Indian/Alaska Native (AI/AN) people.
Goals: To develop culturally relevant 5 and 15 hour breastfeeding courses for Indigenous breastfeeding supporters and people working in Tribal communities, that meets the competencies necessary for fulfilling Baby-Friend Hospital Initiative (BFHI) designation requirements. Additionally, the project is dedicated to creating a 45 hour course for Indigenous Breastfeeding Counselors.
Methods: Utilizing the expertise of Native consultants from across the United States, a Native IBCLC developed a BFHI compliant 5 hour course, which incorporated issues specific to Native communities, photographs of indigenous women, and was trialed in AI/AN communities.
Results: Course content included culturally specific elements such as talking circles, trauma-informed care, food sovereignty, and water rights. The course was piloted with three tribal communities in New Mexico/Arizona, Montana and Alaska. Feedback was incorporated, and local traditions were honored.
Conclusions: By providing culturally specific breastfeeding education, breastfeeding supporters will be better equipped to serve the communities they are from and in which they work. The course will also help clinical settings in AI/AN settings to achieve and maintain Baby Friendly designation.
Advocacy for health and health education Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Increased Early Exclusive Breastfeeding in South Africa from 2010 to 2013 Coinciding with 2011 National Infant Feeding Policy Change
Debra Jackson, BSN MPH DSc1, Sonja Swanevelder, MSc2, Tanya Doherty, PhD2 and Ameena Goga, PhD3
(1)UNICEF, NY, NY, (2)South African Medical Research Council, Cape Town, South Africa, (3)South African Medical Research Council, Pretoria, South Africa
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: South Africa has been reported to have one of the lowest Exclusive Breastfeeding (EBF) rates in Africa, with rates between 1998 and 2009 in infants aged 0-3 months from 6% to 14.9%. In 2011, the Minister of Health held a consultation on infant feeding, which led to a shift in national policy to promote EBF through the release of the ‘Tshwane Declaration'. Free formula for HIV-positive mothers was withdrawn from the PMTCT programme and EBF messaging for front line healthcare workers was emphasized as a policy priority. This analysis aims to examine changes in EBF rates in 2010 prior to the Tshwane Declaration, in 2011-12 during the policy transition, and 2012-13 after the Declaration.
Methods: Data from three national, cross-sectional, facility-based surveys with stratified multi-stage probability sampling proportional-to-size were analysed. Participants were caregivers with infants aged 4-8 weeks. Interviews gathered data on maternal socio-demographics, and maternal health services. Infant feeding was determined using a structured 24 hour recall. EBF was defined according to WHO definitions. Data were weighted for sample realisation and population live births.
Results: 4-8 week EBF rates were 23.6% in 2010, 36.5% in 2011, and 60.4% in 2012, p<0.001. Exclusive Formula Feeding (24.7% to 16.5%), Mixed Breastfeeding (19.0% to 15.1%) and early solids introduction saw significant reductions (p<0.001) from 2010 to 2012.
Conclusion: With what seemed to be an intransigently low EBF rate since 1998, South Africa saw a remarkable increase in early EBF from 2010 to 2013 coinciding with major national infant feeding policy change.
Public health or related public policy
Abstract
Latino Best Start Curriculum: Development and Implementation of Community Based Programs that Support Breastfeeding in the Latino Community
Nara Hojvat-Gallin, MPH1, Lorena Gonzalez, PhD1 and Luis Torres, PhD2
(1)Urban Strategies, Arlington, VA, (2)University of Houston, Houston, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
While rates of initiating breastfeeding are relatively high among Hispanics living in the United States, they fall short of the goals for Healthy People 2020. Latino Best Start was funded to support Hispanic-serving community-based organizations' efforts to promote, educate, and support the practice of exclusive breastfeeding in the Hispanic community.
27 focus groups were conducted. At each of nine different sites, three distinct groups of people - 1) mothers/fathers/families, 2) Hispanic business people/owners, and 3) health workers serving Hispanic families, were gathered for facilitated conversations about health, identity and culture, and breastfeeding practices and attitudes. Data was coded looking for major and minor themes.
Focus groups participants identified strongly with both their Hispanic and American culture and traditions. They repeatedly discussed the importance of family in their culture and mentioned health as a significant cultural weakness. Across sites, health care providers perceived themselves as providing culturally appropriate care but upon further exploration their understanding of the Hispanic culture appeared limited. Most focus group participants breastfed and understood the benefits of breastfeeding but they did not get the needed support from work and family and they felt disempowered when engaged in the health care system.
Focus group data suggests that breastfeeding promotion programs for Hispanics must be tailored to the needs of individual communities and include family, culture, and a focus on “health leadership” as a means of self-advocacy. The focus groups also revealed that working with health care providers to provide lactation support for new mothers is essential.
Advocacy for health and health education Diversity and culture Implementation of health education strategies, interventions and programs Program planning
Abstract
Community Health Workers implement a Positive Deviance approach to expand on successful breastfeeding practices in migrant farmworker communities
Randal McCallian, MPH, IBCLC, CD(DONA)
MHP Salud, Aurora, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The Instinto Maternal program took an innovative approach to improving breastfeeding practices in migrant farmworker communities in Florida, Michigan, and Ohio, by combining the community-based Positive Deviance approach with proven methodologies from Community Health Worker (CHW) practice. The Positive Deviance approach is based on the idea that in every community there are individuals who successfully engage in target health behaviors and their strategies, once identified, can be promoted to improve health. As trusted members of the community, CHWs are the ideal candidates to collect accurate and informative data in a culturally appropriate manner to identify ‘positive deviants'. This presentation will highlight how these two innovative concepts can be used in tandem to develop community-driven supports to improve breastfeeding rates.
Breastfeeding ‘Positive Deviants' were surveyed (96) and interviewed (29) in 11 counties across three states. The Positive Deviance research identified the following factors which led to more exclusive breastfeeding, including: “inner circle” support of the breastfeeding mother (especially from the husband/partner), mother's confidence in her ability to breastfeed, and accurate knowledge of milk supply management. Factors that served as barriers which persist in the community include: the perception that formula has benefits and perceived insufficient milk supply, especially in the immediate postpartum. Using this research, strategies for program implementation that were developed include: community education about the importance of breastfeeding (with a focus on educating men), training mothers in the community as peer counselors, and increasing support of pregnant and breastfeeding mothers.
Assessment of individual and community needs for health education Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning Provision of health care to the public
Abstract
Breastfeeding coordinators, nutritionists, and peer counselors describe organizational challenges, strategies, and benefits of delivering a multicomponent intervention to promote exclusive breastfeeding in New York State WIC sites
Johanna D. Eldridge, PhD Candidate1, Lynn Edmunds, DrPH, MS, RD1, Furrina Lee, PhD2 and Jackson Sekhobo, PhD, MPA1
(1)New York State Department of Health, Menands, NY, (2)New York State Department of Health, Albany, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: To improve exclusive breastfeeding rates, 12 NYS WIC sites piloted a multicomponent intervention to increase pregnant women's knowledge, confidence, and support to breastfeed. This qualitative analysis explored staff-identified barriers, facilitators, and contextual factors that influence implementation feasibility in the context of existing WIC clinic operations.
Methods: The Breastfeeding Attrition Prediction Tool was used to identify potential barriers to breastfeeding and develop tailored counseling offered through multiple contacts during pregnancy and early post-delivery. Two months post-implementation, staff implementers (n=22) described implementation experiences in facilitated group discussions(FGDs). FGD data (including staff-authored consensus summaries and researcher field notes) were thematically analyzed.
Results: Organizational norms challenged key implementation processes: usually participants initiated contacts which challenged proactive participant contact required by the intervention (discovering moms had given birth, contacting moms post-delivery); usually staff-availability drove appointment-scheduling which challenged nutritionist continuity. The intervention's longitudinality posed challenges, specifically: Monitoring participant contacts/corresponding materials, preparing for follow-up contacts, maintaining staff enthusiasm.
Staff developed strategies addressing challenges: Contacting moms through photo-texts, social media; Developing participant-tracking systems; Creating timelines outlining participant contacts/corresponding materials; Ongoing trainings to reinforce intervention protocol and motivate staff.
Despite challenges, staff described unanticipated benefits: Tailored counseling improved staff-participant communication, focused education, encouraged participants to share breastfeeding concerns; Nutritionist continuity promoted “stronger relationship” with moms; Case conferencing improved staff communication.
Conclusions: Results highlight staff-identified organizational practices that can challenge but also be modified to facilitate successful implementation, enhancing support for exclusive breastfeeding in WIC. Results also highlight the importance of evaluating program implementation to improve future translation efforts.
Administer health education strategies, interventions and programs Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs