Journal of Human Lactation最新文献

Background: Breastfeeding provides significant benefits for infant health and well-being. However, many mothers develop avoidance behaviors due to the physical, psychological, and sociocultural challenges they encounter during the breastfeeding process.

Research aim: The purpose of this study was to create and assess the Breastfeeding Avoidance Scale's psychometric features in Turkish postpartum mothers.

Methods: A cross-sectional, methodological, and descriptive design was used to assess 227 postpartum mothers. The Breastfeeding Avoidance Items were developed based on an extensive review of the literature, and include 18 items across two subscales. Reliability was assessed using Cronbach's alpha and test-retest techniques, while validity was assessed using expert feedback and exploratory factor analysis.

Results: A two-factor structure that accounted for 63.06% of the variation was found using exploratory and confirmatory factor analysis. A satisfactory model fit was shown by confirmatory factor analysis (χ²/df = 2.90, RMSEA = 0.08, CFI = 0.91). Breastfeeding Avoidance Items showed great test-retest reliability (r = 0.82, ICC = 0.861) and excellent internal consistency (Cronbach's alpha = 0.965). Concurrent validity was supported by the finding of a substantial negative correlation (r = -0.743, p < 0.01) between the Breastfeeding Avoidance Items and the Breastfeeding Self-Efficacy Scale.

Conclusion: The Breastfeeding Avoidance Items is a valid and reliable tool for evaluating Turkish mothers' avoidance of breastfeeding. It offers potential for use in clinical and research settings to identify and address challenges in breastfeeding practices.

Introduction: There is a scarcity of literature documenting how women facing maternal morbidity issues deal with challenges to breastfeeding. This case study documents challenges faced by two women, one who underwent major abdominal surgery immediately after a Caesarean section at 32 weeks, and the other who had a primary and secondary postpartum hemorrhage with repeated hospital admissions.

Main issue: In the first case, the key issues for lactation were the mother-infant separation and difficulty in initiation and sustaining breastfeeding due to abdominal surgery after her Caesarean section. Early and frequent removal of milk are critical for establishing and sustaining supply and were challenging for the mother in the intensive care unit for 3 weeks. The second case involved a mother experiencing severe postpartum hemorrhage. Having lost over 3 L of blood, this mother faced a significant risk of a reduction in prolactin and activation of her milk supply. Her subsequent weakness and dyspnoea due to anaemia meant breastfeeding required extraordinary effort.

Management: Establishing lactation under these circumstances was challenging. Both mothers needed guidance and encouragement to build up and maintain their supply and the practical support of family to care for the infant. In Case Study 1, donor milk was used and alternated with artificial breastmilk substitutes until the mother re-established her supply after discharge. In Case Study 2, the mother required help to express, position, and hold the baby while she breastfed.

Conclusion: Despite overwhelming medical and physiological odds, it is possible to establish exclusive breastfeeding with consistent personalized health-system support/training and relentless determination.

Background: Postnatal breastfeeding rates are low, so breastfeeding education is necessary and should be initiated prenatally. Standard breastfeeding education methods have shown limited effectiveness. Therefore, there is a need for innovative, memorable, and engaging breastfeeding education approaches during the prenatal period.

Research aims: This study aimed to evaluate the effect of antenatal breastfeeding education delivered through the Pecha Kucha method on postpartum breastfeeding self-efficacy, infant feeding attitude, and breastfeeding satisfaction.

Method: This randomized controlled study was conducted with 70 pregnant women-35 in an experimental group and 35 in a control group-at the gynecology and obstetrics clinic of a hospital. The data were collected using the Descriptive Information Form, Antenatal Breastfeeding Self-Efficacy Scale, Postpartum Breastfeeding Self-Efficacy Scale (PBSS), Infant Feeding Attitude Scale (IFAS) and the Visual Analog Scale-Satisfaction (VAS-S).

Results: In the study, in the control group, IFAS scores significantly decreased between baseline and both the 2nd and 4th week assessments, whereas in the experimental group, scores significantly increased (p < 0.001). PBSS scores significantly increased in the experimental group (z = -3.519, p < 0.001). The mean VAS-S scores increased in the experimental group (p = 0.001), while they decreased in the control group (p = 0.005).

Conclusion: Breastfeeding education delivered via the Pecha Kucha method increased postpartum breastfeeding self-efficacy, positively influenced infant feeding attitudes, and enhanced breastfeeding satisfaction, suggesting it may be a promising and innovative approach for antenatal breastfeeding education.

Background: Women with diabetes have an increased risk of delayed Lactogenesis II, and their infants are at higher risk of hypoglycemia and formula supplementation.

Research aim: To assess the feasibility and acceptability of routine postpartum colostrum expression for women with diabetes, and its influence on exclusive breastfeeding.

Method: A non-randomized feasibility clinical study was conducted from birth to 30 days postpartum involving women with DM, including those with GDM, from a maternity in São Paulo, Brazil in 2021-2022.We aimed to identify challenges related to participant acceptance, adherence to the intervention, retention, and the rates of exclusive breastfeeding, in preparation for a full randomized controlled trial (N = 30). The intervention consisted of providing participants with education on the postpartum colostrum expression as a routine practice and offering the expressed milk to their infant after breastfeeds sessions.

Results: We analyzed data from all 30 participants, with 13 in the intervention group and 17 in the control group. More women in the intervention group (12/13, 92%) exclusively breastfed at hospital stay compared with those in the control group (8/17, 47%; p = 0.017). Women in the intervention group reported increased confidence in breastfeeding. Despite barriers like challenges with expression techniques, concerns about milk volume, and labor fatigue, participants found the intervention acceptable.

Conclusions: Postpartum colostrum expression was feasible and acceptable, and may influence exclusive breastfeeding rates among women with diabetes, supporting further research in a larger trial.

Background: According to the human milk banking guidelines in Japan, issued in 2014, pasteurized donor human milk (PDHM) is discarded 24 hours after thawing. However, previous studies have suggested that PDHM remains safe for administration to preterm infants for up to 48 hours after thawing, potentially reducing unnecessary wastage.

Research aim: This study aimed to assess the microbiological safety and the preservation of nutritional and immunological properties of PDHM stored under refrigeration for up to 48 hours after thawing.

Methods: This was a paired-sample experimental study evaluating the safety and composition of PDHM during refrigerated storage after thawing. Individual pasteurized milk samples from 40 donors were thawed overnight in a refrigerator and analyzed at 24 and 48 hours. Samples were cultured on sheep blood agar and incubated for 48 hours at 35 °C to assess bacterial growth. Macronutrients, micronutrients, and immune substances (sIgA and lactoferrin) were measured using specialized analyzers and ELISA kits. The pH of the samples was determined at 24 and 48 hours using a tabletop pH analyzer.

Results: Small but statistically significant changes were observed in several components during 48 hours of storage. Fat, carbohydrates, calcium, inorganic phosphorus, sIgA, and lactoferrin showed slight variations, while protein and zinc remained stable. Fat decreased after 24 hours compared with immediately after pasteurization but did not decline further at 48 hours. The mean pH increased slightly from 7.047 to 7.102 (p = 0.003). No bacterial growth was detected at either 24 or 48 hours.

Conclusions: Although minor biochemical changes occurred, these were not clinically significant. Extending PDHM use to 48 hours after thawing maintained its nutritional and microbiological integrity and could inform revisions to current Japanese milk bank guidelines.

Background: Human milk expression can provide milk removal in place of or in conjunction with an infant that is not exclusively breastfeeding. Although much information is available about milk expression for mothers of premature infants, there is little information about milk expression for mothers of full-term infants.

Research aim: The objective of this scoping review is to examine information about milk expression for mothers of full-term infants.

Method: A scoping review was conducted using the Joanna Briggs Institute Manual for Evidence Synthesis: Scoping Reviews. Articles (N = 1476) from Pub Med, Cochrane Database of Systematic Reviews, CINAHL, and Scopus were screened. A total of 69 English language articles published from 2014 to 2024 were included.

Results: For mothers of full-term infants, regular milk expression was associated with earlier cessation of human milk feeding. Women viewed milk expression as useful but had mixed feelings about the practice. The most common negative theme was the time-consuming nature of milk expression. Women reported a lack of practical guidance and support around milk expression, especially for those who are exclusively pumping. Pump technology is improving in efficiency and comfort, but few guidelines and strategies are available regarding how to best use this technology.

Conclusions: Lack of practical guidance, recommendations, and support highlight a critical need for improved education and resources to help women navigate milk expression effectively.

Background: Research and education on lactation often overlooks the needs and experiences of transgender men and non-binary individuals who are chestfeeding. Support from partners and compassionate, informed healthcare practitioners can significantly enhance their chestfeeding experience.

Research aim: Guided by queer phenomenology, the purpose of this study was to explore the experiences of chestfeeding from the perspectives of transgender men and non-binary people.

Methods: This qualitative study followed the tenets of interpretive description. Semi-structured interviews were conducted with transgender men and non-binary people in Ontario, Canada, who had recent chestfeeding experiences.

Results: Transgender men and non-binary people (N = 8) identified a variety of facilitators and barriers to chestfeeding. Having access to support systems, knowledgeable practitioners who provide gender-affirming care, and bodily autonomy were protective factors through the chestfeeding experience. In addition, planning and preparing for chestfeeding experiences added to positive experiences with chestfeeding. Gender dysphoria and transphobic societal norms were barriers to chestfeeding.

Conclusion: The chestfeeding experiences of transgender men and non-binary parents are shaped by the presence or absence of gender-affirming and knowledgeable care. Disorienting experiences, including misgendering and inadequate support, can disrupt lactation and harm well-being, while affirming interactions enhance embodiment and self-advocacy. This study suggests there is a need for inclusive policies, comprehensive provider education, and practices that affirm diverse gender identities across the perinatal period.

This interview is a personal narrative of Dr. Rafael Pérez-Escamilla's academic and professional journey. He received his BS in Chemical Engineering at Universidad Iberoamericana in Mexico City and then obtained his MS in Food Science and PhD in nutrition at UC Davis. In one of his courses, breast milk was presented as an essential and powerful biological tissue. Realizing that breastfeeding practices in Mexico were less than optimal, he pursued a PhD in maternal and infant nutrition in Mexico. He conducted the first experimental study examining the impact of two steps combined Step 5 (breastfeeding support) and Step 7 (rooming-in) of what later became known as the Baby Friendly Hospital Initiative. He led and co-led several groundbreaking studies, including those that informed the PROBIT trial, and is currently Professor of Public Health at the Yale School of Public Health. He developed the Breastfeeding Gear Model, which identified eight key "gears" to protect, promote, and support breastfeeding on a large scale. More recently, he co-led the 2023 Breastfeeding Lancet series, which examined why, despite all the evidence, breastfeeding rates around the world remain suboptimal. It stressed that breastfeeding is a collective societal responsibility that involves health systems and social and economic policies and can be influenced by industry pressures. Throughout the narrative, Dr. Pérez Escamilla also highlights major paradigm shifts. Breastfeeding is crucial for planetary health as it helps to mitigate carbon emissions, protect the environment, and incur less cost than commercial milk formulas. His ongoing research and professional mission are to protect, promote, and support breastfeeding globally through evidence-based, equitable, and sustainable practices.

Background: It is medically known that breast milk is an important source of nutrition for the growth and development of babies. Following the February 6, 2023 Earthquake in Turkey, calls for breast milk donation were made on social media to meet the milk needs of babies whose mothers passed away.

Research aims: The aim of this study is to examine breast milk donation calls during the disaster period from a bioethical perspective and analyze the challenges and potential solutions specific to Turkey.

Methods: We designed an internet-based qualitative research study. The research data were obtained from Twitter posts about breast milk donation during the earthquake period between February and April, 2023.

Results: We identified two main contexts regarding breast milk donation: culture and belief, and health. The main themes within culture and belief were culture and religion. The main themes within health were misinformation, infection risk, alternative food, milk bank organizations, and allergy risk.

Conclusion: The study emphasizes that cultural norms strongly influence breast milk donation. In bioethics, milk donation during disasters should prioritize the social needs of infants while considering societal values. It is important to emphazise that despite misinformation, breast milk remains the best source of infant nutrition.