Leader or left behind: national and international policies related to breastfeeding.

The U.S. and international breastfeeding policies over the past 80 years present a pattern of increased protection for women and children that influences breastfeeding acceptance. These begin with the Maternity Protection Convention of the International Labor Organization in 1919 and continue through the relatively recent establishment of the U.S. Breastfeeding Committee. State and U.S. federal laws lag well behind international action, and the U.S. record on adopting international initiatives is poor. Nurses can play an influential role in consciousness raising, policy development, and advocacy for breastfeeding support.

The synchrony of mother-infant needs.

Growing evidence continues to demonstrate the benefits infants derive from breastfeeding, and the connection to natural births and breastfeeding is made apparent; however, mothers may misunderstand. They may mistakenly believe they must sacrifice in order to give their infants the best start in life. Childbirth educators can help mothers understand how they, too, may personally benefit from natural childbirth and breastfeeding. These mother-infant needs are not competitive; instead, they are synchronous.

Advocacy and reform for the birth environment.

Childbirth educators can become a part of reform efforts to improve maternity services by helping to create consumer demand for such services.

Selected researched evidence supporting the work of launching families.

Research studies have been abstracted to support action items in a Blueprint for Transforming the Lives of Children, through the childbearing and early child rearing phases of family life. The abstracts relate to childbearing. Similar abstracts related to child rearing can be found at www.aTLC.org.

The evolution of childbirth educator to perinatal educator.

The field of childbirth education has been slowly expanding its base to that of perinatal education over the last decades. This is a call to define the scope of a comprehensive perinatal education program and the skills of a perinatal educator.

Birth environments.

Childbirth educators can actively participate in the birth environment and, thus, greatly contribute to the re-emerging childbirth movement.

Sharing your wisdom: the perinatal author.

Perinatal educators are encouraged to consider the scope of their impact on launching new families by sharing their wisdom through authorship.

Web wisdom, birth or other life transitions, and the pursuit of happiness.

This perspective on "happiness as a way" rather than focusing on finding a path to happiness may be particularly relevant for new and expectant parents.

The versatility of the perinatal educator.

Perinatal educators can expand their role beyond that of childbirth preparation. One such role is the perinatal bereavement counselor. Having the courage to balance one's skills with one's intuitive impulses may greatly enrich carrying out this or any role.

The quest to promote ideal early parenting philosophy, skills, and education.

Prenates, babies, and children deserve wholesome parents and parenting, now. This is the time in which we are all living and growing. The quest for more optimal parenting will bring about more whole-loving beings. Our children and our planet deserve our best effort. Readers can contribute to coalition building towards that aim.

Leaving a lamaze legacy.

The author reaches out across the years to establish a new link with Madame Blanche Cohen and acknowledge her legacy in ongoing efforts to promote natural childbirth.

Breast-milk sodium as a predictor of breastfeeding patterns.

This study partially replicates and extends a study reporting that elevated breast-milk sodium BM [Na+] during early lactogenesis was predictive of poor breastfeeding outcomes. The present study used 6-day postpartum breast milk. Consistent with the findings of the earlier study, 80% of those with a BM [Na+] of 16 mmol/L or lower at day 6 sustained a high level of breastfeeding at week 4, compared to only 50% of those with an elevated BM [Na+] (chi 2 = 4.05, df = 1, p = .04). This difference was even greater in a subgroup of mothers predicted to be at high risk for insufficient milk supply on the basis of support density and self-perception variables. Of the latter group, 75% with low BM [Na+] sustained a high level of breastfeeding at 4 weeks postpartum, compared to only 22% with an elevated BM [Na+] (chi 2 = .65, df = 1, p = .01). In contrast, among the low-risk mothers BM [Na+] levels were not associated with any difference in breast-milk sustainment (89% and 82% sustainment for low- and high-sodium groups, respectively). Thus a normal drop in BM [Na+] is predictive of higher sustainment of breastfeeding. However, the predictive validity of this marker appears to be enhanced by combining it with the psychosocial variables of support density and self-perception of breastfeeding by the mother.

Breastfeeding and health professional encouragement.

The objective of the study was to ascertain the nature of health professional contacts related to breastfeeding for 341 women. Subjects were prospectively queried by phone or home visit over a 20-week period regarding the number and nature of contacts with health care professionals related to breastfeeding. Lactation consultants gave significantly more positive encouragement (98%) (p = .01) than either nurses (75%) or physicians (68%) did. However, of the 233 health provider contacts that included breastfeeding advice, only 21% involved lactation consultants. Primiparae were likely to decrease their level of breastfeeding if a health professional encouraged supplemental foods (39%) or weaning (86%) during the prior week. Multiparae who were experienced at breastfeeding (3+ weeks breastfeeding the previous infant) decreased their breastfeeding slowly across the weeks with the current infant, and their level of breastfeeding in general appeared independent of health care provider advice. Multiparae who lacked previous sustained breastfeeding experience (0-3 weeks) had the most rapid decrease (65%) in their breastfeeding rates even with health care provider encouragement to continue. Thus, they too appeared to act independently of health care provider advice.

Effects of parity and weaning practices on breastfeeding duration.

The purpose of this project was to examine (a) patterns of breastfeeding and (b) duration with parity and breastfeeding experience, and (c) mothers' reasons for termination of breastfeeding. A convenience sample of 120 breastfeeding mothers was followed by home visits and telephone for 20 weeks after delivery. The sample consisted of 69 primiparas, 40 multiparas with previous breastfeeding experience, and 11 multiparas with no prior breastfeeding experience. Parity was not significantly associated with the continuation of breastfeeding but there was a trend toward a difference made by breastfeeding experience. Inadequate milk supply and employment were the two most common reasons reported for weaning. Implications for support in the workplace and for first-time breastfeeding mothers are discussed.

Does early supplementation affect long-term breastfeeding?

The purpose of this secondary data analysis from two different samples was to examine the effect of early supplementation with manufactured milks on breastfeeding status at 20 weeks postpartum in mothers of healthy term infants. In two convenience samples of 120 and 223, respectively, breastfeeding mothers were followed up for 20 weeks postpartum or until weaning occurred. The breastfeeding rate at 20 weeks postpartum was significantly greater for mothers who reported feeding exclusively mother's milk the second week after delivery compared with mothers who breastfed and simultaneously supplemented with manufactured infant milks. Of the mothers in samples one and two who exclusively fed human milk during week 2 postpartum, 63.0% and 59.7%, respectively, were still breastfeeding at week 20, compared with 28.1% and 24.2%, respectively, who supplemented with artificial milks. There was no significant difference between these two groups of mothers and their intended duration of breastfeeding. Early introduction of supplemental bottles of artificial milks is associated with a decrease in the amount of human milk the infant receives as well as with early weaning.

Development of the H & H Lactation Scale.

Psychometric properties of the H & H Lactation Scale, based on the Insufficient Milk Supply (IMS) conceptual framework, were examined in two separate studies. The two convenience samples consisted of 110 mothers of low-birth-weight (LBW) infants and 120 mothers of healthy term infants. Both groups planned to breastfeed and were actively breastfeeding or pumping to maintain a milk supply. Subscales identified by factor analysis measured three concepts: maternal confidence/commitment to breastfeeding, perceived infant breastfeeding satiety, and maternal-infant breastfeeding satisfaction. All subscales showed moderate to high internal consistency (alphas .75 to .98) as well as concurrent and predictive validity. The total scale and the three subscales were prospectively significantly related to level of breastfeeding 8 weeks after delivery with both groups of mothers.

Comparison of subjects who fully versus minimally participated in a breast-feeding study.

Sampling bias occurs in research when a large percentage of subjects who are eligible for the study refuse to participate. During Phase I of a two-phase multisite Mother-Baby Feeding Project, approximately 50% of the 235 potential participants at four of five sites declined to enter the study. This report compares subjects who fully participated with those who minimally participated and explores factors related to subjects' refusal to participate. Data regarding sociodemographic data, breast-feeding experience, and reason for refusal were collected from 92 subjects who declined to enter but agreed to minimally participate. The fully participating subjects had more education than those who participated minimally. However, the breast-feeding outcomes studied were similar for both groups. This provides support for generalizing additional study findings beyond the group of fully participating subjects when considering breast-feeding outcomes. Findings lend insight into the problem of subject recruitment that is not well-addressed in the nursing literature.

The occurrence of breast engorgement.

This study describes breast engorgement during days 1-14 postpartum of 114 first and second time vaginal- and cesarean-delivery breastfeeding mothers. Most mothers reported experiencing their most intense engorgement after hospital discharge. Previous breastfeeding experience of the mother is a more critical variable than parity in predicting engorgement. Second time breastfeeding mothers experienced engorgement sooner and more severely than did first time breastfeeding mothers, regardless of delivery method. Anticipatory guidance by the care provider is discussed in an effort to enhance the experience of the breastfeeding dyad.

Breast engorgement: patterns and selected outcomes.

For 14 days following birth, 114 breastfeeding mothers rated their level of breast engorgement twice daily, using a six-point engorgement scale. Individual engorgement ratings were plotted by intensity over time to provide a visual display of each subject's breast engorgement experience. Four distinct patterns of breast engorgement emerged; mothers experienced either a bell-shaped pattern, a multi-modal pattern, a pattern of intense engorgement, or a pattern of minimal engorgement. Characteristics of mothers and infants, and feeding frequency were similar across the four breast engorgement patterns.