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Health professionals' advice for breastfeeding problems: Not good enough!
Lisa H Amir, Jennifer Ingram
International Breastfeeding Journal , 2008, DOI: 10.1186/1746-4358-3-22
Abstract: "Acute mastitis is an all too common disease which has not had the attention it deserves" [1] (p. 635).Mastitis is "an inflammatory condition of the breast, which may or may not be accompanied by infection" [2] (p. 1). Scott et al's paper recently published in the International Breastfeeding Journal shows that health professionals are still giving harmful advice to women with mastitis [3]. Ten percent of women were advised to stop breastfeeding and many were prescribed an inappropriate antibiotic [3]. In practice, we regularly hear stories from women with mastitis about incorrect advice they have been given by their health care providers: overuse of antibiotics, misuse of antibiotics (wrong medicine or wrong dose), advice to stop breastfeeding (either because of the mastitis or "concerns" regarding the effect of maternal medicines on the infant), or misplaced emphasis on maternal rest leading to skipping feeds overnight.Mastitis can be seen as an illustration of health professionals' management of wider breastfeeding issues. Mastitis is a problem experienced by 15 to 20% of breastfeeding women [3-5]; women find it distressing, both physically and emotionally [6,7]. Since it is not always caused by an infection, but may be the result of poor milk drainage, it may not require antibiotics (see Breastfeeding Network leaflet for self-help measures [8]). If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis?Mastitis is poorly researched:- compared to breastfeeding in general, there have been few papers on mastitis; a rough estimate using PubMed to search for "mastitis (limited to humans)" and for "breastfeeding" reveals 45 publications about mastitis and 247 about breastfeeding in 1977 (1:5.5) – 30 years later in 2007, there were 81 publications on mastitis and 1386 on breastfeeding (1:17.1);- there is no agreed definition or diagnostic criteria
Ways ahead: protecting, promoting and supporting breastfeeding in the context of HIV
Karen Moland, Penny van Esterik, Daniel W Sellen, Marina M de Paoli, Sebalda C Leshabari, Astrid Blystad
International Breastfeeding Journal , 2010, DOI: 10.1186/1746-4358-5-19
Abstract: As a final note, let us return to breastfeeding for a moment and discuss how to counteract the pressures that have been exerted against breastfeeding in the context of HIV. As history shows, the threats to breastfeeding have changed over time. During the last decade the greatest threat to breastfeeding has been the confusion over infant feeding in the wake of the HIV pandemic. Through national and local PMTCT programmes and HIV information campaigns, the global community has learnt that breastfeeding in HIV-infected mothers may be a risk to child survival and should, if possible, be avoided. The uncertainty that this has generated is illustrated in this thematic series. In the early phase of the national and local PMTCT programme implementation, breastfeeding advocacy groups were accused of having their "heads in the sand" about the transmission of HIV through breastfeeding. The existing evidence of the superiority of breastfeeding in terms of infant survival, and the 2010 infant feeding guidelines promoting breastfeeding as the first choice of infant feeding method, have demonstrated that the advocacy groups were right in their firm and concerted action to protect breastfeeding. One lesson is learnt: replacement feeding has substantial negative unintended consequences for the individual mother, for her infant, for households and for health systems. In the aftermath of a decade of trial and error in developing guidelines and implementing postnatal PMTCT programmes, the trust in breastfeeding thus needs to be restored. The challenge is how to 'turn the tide' or change the mindset of PMTCT counsellors, mothers and significant others towards breastfeeding as the safest way to feed an infant. The research studies reported in this thematic series suggest that this may prove challenging given the legacy of efforts to implement earlier guidelines. In the first concluding remarks we focused on global policy documents and lessons learnt [1]. Now in this final paper we consid
Breastfeeding training for health professionals and resultant changes in breastfeeding duration
Taddei, José Augusto de Aguiar Carrazedo;Westphal, Marcia Faria;Venancio, Sonia;Bogus, Cláudia;Souza, Sonia;
Sao Paulo Medical Journal , 2000, DOI: 10.1590/S1516-31802000000600007
Abstract: context: promotion of breastfeeding in brazilian maternity hospitals. objective: to quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the wellstart-slc course, comparing them with changes among mothers attended by institutions not exposed to this course. design: randomized institutional trial. setting: the effects of training on breastfeeding duration was assessed in eight brazilian hospitals assigned at random to either an exposed group (staff attending the wellstart-slc course) or a control group. sample: for each of the eight study hospitals, two cohorts of about 50 children were visited at home at one and six months after birth. the first cohort (n = 494) was composed of babies born in the month prior to exposure to the wellstart-slc course, and the second cohort (n = 476) was composed of babies born six months subsequent to this exposure. main measurements: kaplan-meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves. hazard ratio (hr) estimates were calculated by fitting cox proportional hazard regression models to the data. results: the increases in estimated, adjusted rates for children born in hospitals with trained personnel were 29% (hr = 0.71) and 20% (hr = 0.80) for exclusive and full breastfeeding, respectively. no changes were identified for total breastfeeding. conclusion: this randomized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration.
A qualitative study of the promotion of exclusive breastfeeding by health professionals in Niamey, Niger
A?ssata Moussa Abba, Maria De Koninck, Anne-Marie Hamelin
International Breastfeeding Journal , 2010, DOI: 10.1186/1746-4358-5-8
Abstract: The purpose of this exploratory study, of which some results are presented here, was to document health professionals' attitudes and practices with regard to exclusive breastfeeding promotion in hospital settings in the urban community of Niamey, Niger.Fieldwork was conducted in Niamey, Niger. A qualitative approach was employed. Health professionals' practices were observed in a sample of frontline public healthcare facilities.The field observation results presented here indicate that exclusive breastfeeding is not promoted in healthcare facilities because the health professionals do not encourage it and their practices are inappropriate. Some still have limited knowledge or are misinformed about this practice or do not believe in it. They do not systematically discuss exclusive breastfeeding with mothers, or they mention it only briefly and without giving any explanation. Worse still, some encourage the use of breast milk substitutes, which are frequently promoted in healthcare facilities. Thus mothers often receive contradictory messages.The results suggest the need to train or retrain health professionals with regard to exclusive breastfeeding, and regularly supervise their activities.The WHO and UNICEF jointly recommend that women exclusively breastfeed their infants for the first six months and continue to breastfeed into the second year of life or longer. This feeding method is the normative model [1]. The importance of breastfeeding, especially exclusive breastfeeding (EBF), is well established for the infant, the mother and the family [2-8] and there are risks of not breastfeeding infants, particularly in poorer environments where social, economic and unsafe hygienic conditions increase the risk of infections and undernourishment. In those settings when infant formula are used, they are introduced early and over-diluted. In Niger, nearly all mothers start breastfeeding and continue until 21 months on average, but only 1% of infants are exclusively breastfed
Breastfeeding knowledge and practice of health professionals in public health care services
Silvestre, Patrícia Kelly;Carvalhaes, Maria Antonieta de Barros Leite;Venancio, S?nia Isoyama;Tonete, Vera Lúcia Pamplona;Parada, Cristina Maria Garcia de Lima;
Revista Latino-Americana de Enfermagem , 2009, DOI: 10.1590/S0104-11692009000600005
Abstract: this study evaluated breastfeeding knowledge and practice of professionals who care for infants at health care services in a city in the interior of s?o paulo, brazil. this epidemiological study was carried out with a population of 89 nurses and physicians. their answers to a structured questionnaire were analyzed in total and by place of work through the test for difference between proportions (chi-square) with the level of significance at p<0.05. data analysis was performed according to the ministry of health recommendations. the significant differences found for knowledge and practice, according to place of work, were restricted to certain aspects. results of average scores were slightly better for professionals from the basic care units. regular and poor performance were found in different studied aspects regardless of place of work, which suggest that potential educational interventions in this subject should include professionals at all levels of health care.
Teaching New Mothers about Infant Feeding Cues May Increase Breastfeeding Duration  [PDF]
Jay Kandiah, Charlene Burian, Valerie Amend
Food and Nutrition Sciences (FNS) , 2011, DOI: 10.4236/fns.2011.24037
Abstract: The objective of this pilot study was to compare two different methods of educating prenatal women regarding breast-feeding. Comparisons were made between traditional and innovative methods to determine which was more effective in increasing breastfeeding duration. Over a 32 month period, 197 prenatal women were assigned to either a control (C, n = 139) or an experimental (E, n = 51) group. The C group received standard breastfeeding education, while the E group received standard education in addition to information about infant hunger cues. Cox Regression and Kap-lan- Meier analysis were performed. Estimated mean number of weeks for C and E groups to continue breastfeeding was 14.3 + 17.4 weeks and 18.5 + 17.1 weeks, respectively. At 26 weeks, duration of breastfeeding approached significance (chi square = 2.907, df = 1, p = 0.088), indicating probability of continuing to breastfeed was about 28% better for those in E group when compared to C group. Duration of breastfeeding may increase when prenatal women are taught to identify infant behavior such as hunger cues.
Expanding the Scope of Faculty Educator Development for Health Care Professionals  [PDF]
Kadriye O. Lewis,Raymond C. Baker
Journal of Educators Online , 2009,
Abstract: Although many medical institutions offer faculty development in education, this does not provide the in-depth knowledge of the science of teaching required for medical education research and careers in medical education. This paper describes our expanding faculty development activities at Cincinnati Children’s Hospital Medical Center (CCHMC) that have culminated in the development and implementation of an innovative Online Master's Degree in Education program. Working in collaboration with the University of Cincinnati College of Education, CCHMC developed an Online Master's Degree in Education program targeting physicians and other health care professionals. The master’s program has proven to be an effective means of developing health care professionals’ educational pedagogy and skills as measured by program growth and outcomes of the participants. Medical institutions may approach faculty development through various methods, but the unique nature of online programs provides more flexible learning opportunities to nurture healthcare professionals beyond traditional programs.
Knowledge, attitudes and practices of health professionals and women towards medication use in breastfeeding: A review
Safeera Y Hussainy, Narmin Dermele
International Breastfeeding Journal , 2011, DOI: 10.1186/1746-4358-6-11
Abstract: In July-October 2010, keywords (e.g. health professionals, doctors, nurses, pharmacists, lactation, breastfeeding, medication, medicine, knowledge, attitude/s, practice/s, behaviour/s) were used, either separately or in combination, to search databases such as Ovid, Pub Med, International Pharmaceutical Abstracts and Google Scholar. The search was restricted to articles published on primary research data, in English, and from 1990 onwards. The same keywords were used to search relevant journals such as BMC Women's Health, Medical Journal of Australia, International Breastfeeding Journal and Journal of Human Lactation. The reference lists of relevant articles retrieved from these journals were hand-searched for additional studies.Thirty-one publications were found that were assessed for relevance to the topic area, 15 of which were not within the scope of this review - 13 that did not investigate health professionals' breastfeeding knowledge, attitudes or practices in the context of prescribing medication for women [1-13]; one that did not determine women's experiences with receiving advice from health professionals on medication use and safety in breastfeeding [14]; and another that was a review of primary research data [15].Tables 1, 2 and 3 show the 17 publications that were critiqued [16-32]. These reported on studies that mostly used cross-sectional designs; generally had low response rates (RRs); and were undertaken in Australia, Canada, Israel, The Netherlands, USA and United Kingdom (UK), and whose findings therefore cannot be generalised to other settings.Table 1 details 11 studies - seven that have been conducted with health professionals only [17,18,21,26,28,31,32] (where references 17-18 and 21 concern the same study); two with pharmacists, general practitioners (GPs) and breastfeeding women together [22,23] (these concern the same study); another with pharmacists and breastfeeding women [25]; and one with endocrinologists, family physicians and women [30
A family practice breastfeeding education pilot program: an observational, descriptive study
Christine M Betzold, Kathleen M Laughlin, Carol Shi
International Breastfeeding Journal , 2007, DOI: 10.1186/1746-4358-2-4
Abstract: The program distributed handouts at each prenatal and well-child visit (up to one year). Using questionnaires, a small audit project evaluated the program's impact on breastfeeding goals, duration, in-hospital exclusivity and maternal perception of success. Mothers completed goal surveys at baseline and post-intervention, usually while waiting for prenatal clinic visits. Duration was assessed by surveys completed during well-infant visits, postal mailings or telephone interviews at breastfeeding cessation, 6 months and 1 year. The outcomes measured were increases in goals, maternal perception of success, duration and in-hospital exclusivity.Participants included 33 women: 48% had a bachelor's or master's degree, 61% were non-Hispanic white, and 67% reported incomes of US$75,000 or higher. At baseline 5/31 planned to exclusively breastfeed for 4–6 months and 5/33 planned to breastfeed for 6–12 months. Post-intervention there was a 200% increase (15/31) in the exclusively breastfeeding 4–6 month group and a 160% increase (13/33) in the 6–12 month duration group. Actual in-hospital exclusivity rates were 61%, 6-month duration rates were 73%, and 12-month rates were 33%. Over 75% of mothers reported feeling successful.This small pilot educational program may have significant impacts on breastfeeding goals. Setting and meeting goals may increase duration and in-hospital exclusivity rates as well as enhance maternal self-perception and empowerment due to succeeding at their breastfeeding goals and/or experiencing a fulfilling breastfeeding relationship.The World Health Organization recognizes the importance of promoting and supporting breastfeeding as the optimal feeding method used exclusively for at least 6 months and continued along with complementary feeding for no less than two years of life [1]. Given that current overall United States (U.S.) breastfeeding rates fall short of these recommendations [2-5], implementation of programs that promote breastfeeding are indi
Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals  [cached]
McDonald Karalyn,Amir Lisa H,Davey Mary-Ann
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-s5-s5
Abstract: Background The perceived risk/benefit balance of prescribed and over-the-counter (OTC) medicine, as well as complementary therapies, will significantly impact on an individual’s decision-making to use medicine. For women who are pregnant or breastfeeding, this weighing of risks and benefits becomes immensely more complex because they are considering the effect on two bodies rather than one. Indeed the balance may lie in opposite directions for the mother and baby/fetus. The aim of this paper is to generate a discussion that focuses on the complexity around risk, responsibility and decision-making of medicine use by pregnant and breastfeeding women. We will also consider the competing discourses that pregnant and breastfeeding women encounter when making decisions about medicine. Discussion Women rely not only on biomedical information and the expert knowledge of their health care professionals but on their own experiences and cultural understandings as well. When making decisions about medicines, pregnant and breastfeeding women are influenced by their families, partners and their cultural societal norms and expectations. Pregnant and breastfeeding women are influenced by a number of competing discourses. “Good” mothers should manage and avoid any risks, thereby protecting their babies from harm and put their children’s needs before their own – they should not allow toxins to enter the body. On the other hand, “responsible” women take and act on medical advice – they should take the medicine as directed by their health professional. This is the inherent conflict in medicine use for maternal bodies. Summary The increased complexity involved when one body’s actions impact the body of another – as in the pregnant and lactating body – has received little acknowledgment. We consider possibilities for future research and methodologies. We argue that considering the complexity of issues for maternal bodies can improve our understanding of risk and public health education.
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