Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study.

Background: Maternity care practices such as skin-to-skin care, rooming-in, and direct breastfeeding are recommended, but it is unclear if these practices increase the risk of clinically significant COVID-19 in newborns, and if disruption of these practices adversely affects breastfeeding. Methods: We performed a retrospective cohort study of 357 mothers and their infants <12 months who had confirmed or suspected COVID-19. Subjects came from an anonymous worldwide online survey between May 4 and September 30, 2020, who were recruited through social media, support groups, and health care providers. Using multivariable logistic regression, Fisher's exact test, and summary statistics, we assessed the association of skin-to-skin care, feeding, and rooming-in with SARS-CoV-2 outcomes, breastfeeding outcomes, and maternal distress. Results: Responses came from 31 countries. Among SARS-CoV-2+ mothers whose infection was ≤3 days of birth, 7.4% of their infants tested positive. We found a nonsignificant decrease in risk of hospitalization among neonates who roomed-in, directly breastfed, or experienced uninterrupted skin-to-skin care (p > 0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms' reach, were significantly less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms (p ≤ 0.02 for each). Nearly 60% of mothers who experienced separation reported feeling "very distressed," and 29% who tried to breastfeed were unable. Presence of maternal symptoms predicted infant transmission or symptoms (adjusted odds ratio = 4.50, 95% confidence interval = 1.52-13.26, p = 0.006). Conclusion: Disruption of evidence-based quality standards of maternity care is associated with harm and may be unnecessary.

Examining the Baby Café Model and Mothers' Breastfeeding Duration, Meeting of Goals, and Exclusivity.

Objective: Accessible community lactation support impacts a woman's breastfeeding success by offering timely intervention and solutions, thereby allowing mothers to achieve breastfeeding goals and improve overall breastfeeding rates. Although the impact of breastfeeding support has been well established, there is a lack of consistency in the development and evaluation of support models. This report examines two differing populations of Baby Café attendees. The study evaluated the mother's achievement of personal and nationally recommended breastfeeding goals, the frequency of attending a Baby Café, and their ratings of the program as helpful in solving breastfeeding problems. Methods: A total of 559 mothers attending two Baby Cafés, one in Massachusetts and the other in southern Texas, were surveyed when their babies were 6 months old and again over age 12 months. Actual breastfeeding duration was compared with the mothers' initially stated goals and American Academy of Pediatrics (AAP) recommended goals, and then evaluated against the number of Café attendances. The mother's rating of the Café for helpfulness was measured using a 1-5 effectiveness scale. Results: Results show that mothers attending either of the surveyed Baby Cafés that served distinctly different populations reported higher breastfeeding exclusivity rates and higher rates of 12-month breastfeeding duration than national rates reported by the Centers for Disease Control and Prevention (CDC). More than 70% of all mothers surveyed rated the Café as most effective. Conclusions: The Baby Café model was shown to be effective at helping mothers reach breastfeeding goals regardless of the Café's different geographical settings and the socioeconomic characteristics of the populations served.

Online Continuing Education for Expanding Clinicians' Roles in Breastfeeding Support.

Lack of health professional support is an important variable affecting mothers' achievement of breastfeeding goals. Online continuing education is a recognized pathway for disseminating content for improving clinicians' knowledge and supporting efforts to change practices. At the time we developed our project, free, accredited continuing education for physicians related to breastfeeding management that could be easily accessed using portable devices (via tablets/smartphones) was not available. Such resources were in demand, especially for facilities pursuing designation through the Baby-Friendly Hospital Initiative. We assembled a government, academic, health care provider, and professional society partnership to create such a tutorial that would address the diverse content needed for supporting breastfeeding mothers postdischarge in the United States. Our 1.5-hour-long continuing medical and nursing education was completed by 1606 clinicians (1172 nurses [73%] and 434 physicians [27%]) within 1 year. More than 90% of nurses and over 98% of physicians said the tutorial achieved its 7 learning objectives related to breastfeeding physiology, broader factors in infant feeding decisions and practices, the American Academy of Pediatrics' policy statement, and breastfeeding management/troubleshooting. Feedback received from the tutorial led to the creation of a second tutorial consisting of another 1.5 hours of continuing medical and nursing education related to breast examination and assessment prior to delivery, provision of anticipatory guidance to pregnant women interested in breastfeeding, maternity care practices that influence breastfeeding outcomes, breastfeeding preterm infants, breastfeeding's role in helping address disparities, and dispelling common myths. The tutorials contribute to achievement of 8 Healthy People 2020 Maternal, Infant and Child Health objectives.

Use of an interactive computer agent to support breastfeeding.

Mothers need consistent, sustained information and support to develop and meet personal breastfeeding goals, but often receive insufficient assistance and conflicting and incorrect advice. The use of technology may be helpful in supplementing existing health care professional breastfeeding education and support efforts. We developed and evaluated a computer-based animated, interactive agent designed to provide breastfeeding information and support to mothers interested in breastfeeding. A randomized controlled study of a first-generation system was conducted to determine the feasibility of (1) use of the Computer Agent; (2) the recruitment plan; and (3) the planned outcome evaluation (assessing the impact of the intervention on intent to breastfeed, attitudes towards breastfeeding, and breastfeeding self-efficacy). The pilot study (N = 15) showed that the use of the Computer Agent, the recruitment plan, and the planned outcome evaluation were all feasible. Mothers who used the Computer Agent had greater intentions to exclusively breastfeed after exposure to the Agent (intent to exclusively breastfeed for 6 months 1-7 scale score of 6.14 (post) vs. 5.14 (pre); p < 0.05). Non-statistically significant trends in improvement with use of the Computer Agent breastfeeding support system were also seen in the between subjects analyses of intent to breastfeed and breastfeeding self-efficacy. The pilot study demonstrated the feasibility of using a Computer Agent to support breastfeeding mothers and informed the design of a larger randomized clinical trial. An interactive Computer Agent may be helpful in improving rates of exclusive breastfeeding, particularly when there is not adequate health care professional support.

The Massachusetts baby-friendly collaborative: lessons learned from an innovation to foster implementation of best practices.

Collaborative efforts among hospitals can facilitate the exchange of ideas, provide a forum for discussing the development of new policies or practices or changes to existing policies and practices, and increase the implementation of best practices. In November 2008, the Massachusetts Breastfeeding Coalition formed a collaborative of maternity facilities wishing to pursue Baby-Friendly designation. Members provided insights from experiences and shared models and examples from outside. We describe highlights from the first 15 months of the Collaborative and present 4 recommendations for overcoming barriers: (1) manage expectations of patients, family/friends, and staff; (2) restrict access to materials that can undermine breastfeeding; (3) adopt the appropriate perspectives to creatively implement change; and (4) bundle, reframe, and harness larger forces. The strategies can be applied across diverse hospital settings.