Exploratory study: barriers for initiation and/or discontinuation of breastfeeding in mothers of children with Down syndrome.

BACKGROUND: The aim of the study is to identify the barriers associated with breastfeeding in mothers of Puerto Rican children with Down. METHOD: A non-probabilistic sample (n = 26) of mothers was used in the study. The sample was obtained in an institution in Puerto Rico specializing in care of infants with Down Syndrome [IDS]. A self-administered questionnaire was used consisting of six sections. Descriptive statistics were used for data analysis. RESULTS: The majority of interviewed mothers (80.8%) had 70.0% or higher correct answers regarding the benefits of breastfeeding. 84.6% of the mothers who decided not to breastfeed or who discontinued breastfeeding reported as the main reason that the baby presented sucking problems and 50.0% of the participants were not allowed to have their baby with them during their stay in the hospital. 84.3% of the participants indicated having breastfed their IDS and 61.5% stated that they would not breastfeed in public places. CONCLUSION: Active support, instruction, and collaboration among members of the health care team are essential for breastfeeding success.

Formula labeling violations to the WHO Code: a quantitative and qualitative analysis.

BACKGROUND: The WHO Code on Marketing of Breastmilk Substitutes is intended to be adopted as a minimum requirement by all governments and aims to protect infant health by preventing inappropriate marketing of breastmilk substitutes. Labels need to have correct and clear dispositions since they frequently are the only source of vital information for consumers regarding the content of the product and its uses. OBJECTIVE: The purpose of this study was to determine violations to the provisions of the International Code Article 9 regarding infant formula labeling existing in Puerto Rico. METHODS: A quantitative and qualitative evaluation of 34 labels of infant formula was done. Instrument 4-A of the IBFAN Monitoring Project (IMPIII) and the Standard IBFAN Monitoring (SIM) was utilized. This instrument included 14 criteria that identified violations to the International Code of Breastmilk Substitutes on labeling. Descriptive analysis was used for all variables. The 34 labels evaluated represent 77.3% of infant formula labels of the four companies which market them in the island. RESULTS: All the labels (100%) that were evaluated were found to violate the Code in one or more of its dispositions. Most striking violations include: a statement that breastfeeding is best is lacking in 73.5%, as well as a statement that the product should be used only on the advice of a health worker. None of the labels are written in Spanish, the local language. Text which may idealize the use of infant formula or discourage breastfeeding is present in 97.1% of the samples, and the same percentage has a photo or picture idealizing the use of infant formula. CONCLUSIONS: It is vital to produce legislation that implants the WHO Code in Puerto Rico in order to regulate indiscriminate marketing practices and their subsequent ill effects on children's health and breastfeeding practices.

Exploratory study: knowledge about the benefits of breastfeeding and barriers for initiation in mothers of children with spina bifida.

The aim of the study is to identify the level of knowledge on breastfeeding by mothers of infants with spina bifida and the barriers encountered in initiating breastfeeding. A non-probabilisitic sample (n=30) of mothers was used in this study. The sample was obtained in two institutions specializing in care for infants with congenital anomalies in Puerto Rico. A self-administered questionnaire was used consisting of six sections. Descriptive statistics were used for data analysis. Among participants, 56.7% had adequate knowledge on the benefits of breastfeeding. The most frequently encountered barriers in initiating breastfeeding were related to the neonatal intensive care unit (NICU). Problems with the medical and nursing procedures, routines, support from personnel, and adequacy of the environment were the most frequent. It is important to develop a education to encourage nurses and other health care professionals need suggest, support and encourage breastfeeding to mothers of infants with neural tube defects.

Full breastfeeding during the postpartum hospitalization and mothers' report regarding baby friendly practices.

OBJECTIVE: The objective of this study was to describe the opinion of a group of postpartum women about compliance with the Ten Steps in a hospital with the intention to be certified as a Baby Friendly Hospital. METHODS: Two hundred (200) postpartum women age 20 or greater who had delivered a healthy full-term baby (37 weeks gestation) participated in the study. Data were gathered by means of a semi-structured questionnaire in the Spanish language. Descriptive and inferential statistics (Chi-square) were used for data analysis. RESULTS: Thirty percent (30%) of participants were 21 to 26 years of age. Primiparas comprised 51% and legally or consensually married mothers comprised 89% of the study participants. Monthly family incomes with the highest frequencies were $0 to $2000 and $2001 to $3000, respectively. Full breastfeeding was being practiced by 43.5% of the mothers in the study, whereas 53.0% were breastfeeding partially. Compliance with the Ten Steps was perceived as deficient by 52% of the mothers, whereas only 5.5% perceived compliance as excellent. The perceived level of compliance with the Ten Steps is significantly associated with the type of breastfeeding (full or partial) in the inferential analyses (X(2) [3, n = 193] = 33.74, p = 0.00) and in the multiple logistic regression analyses (OR = 1.27, confidence interval [CI] = 1.14 - 1.43, p = 0.00). As the level of perceived compliance with the Ten Steps increases, the probability of full or exclusive breastfeeding also increases. CONCLUSION: Compliance with the Ten Steps of the Baby Friendly Hospital from the perspective of the postpartum mother has an impact on the type of breastfeeding.

Exploratory study: breastfeeding knowledge, attitudes towards sexuality and breastfeeding, and disposition towards supporting breastfeeding in future Puerto Rican male parents.

Identify the breastfeeding knowledge, the attitudes towards sexuality and breastfeeding and the disposition towards supporting breastfeeding in future fathers were the aims of this study. A non-probabilistic sample (n = 100) of future Puerto Rican male parents was used in this study. A self-administered questionnaire was used consisting of four sections. Descriptive statistics were used for data analysis and t-test to the inferential analysis. 88.8% of the participants presented a low level of knowledge. However, 81.6% had a positive attitude toward sexuality and breastfeeding. Also, 92.0% of the participants indicated much/enough willingness to support their partners in exclusively breastfeeding. Disposition to support the breastfeeding was associated with knowledge towards breastfeeding (p = 0.04) and attitudes toward sexuality and breastfeeding (p = 0.00). The knowledge and the attitudes, in this study, are strongly related with the disposition of the father to supporting the breastfeeding in the future.

Effectiveness in the implantation of law 155 of 2002 ordering the designation of spaces for breastfeeding in government agencies.

UNLABELLED: As part of an effort to promote and protect breastfeeding among working mothers in Puerto Rico, Public Law 427 was passed in December 2000. This law grants a paid breastfeeding daily break for milk extraction in the workplace. In support of this initiative Public Law 155 was passed in 2002 ordering Secretaries, Directors, Presidents and Public Administrators of the government of Puerto Rico to designate breastfeeding spaces in the workplaces. OBJECTIVE: Describe the level of compliance with the dispositions of Law 155 in government agencies. METHODOLOGY: A cross sectional descriptive study was carried out. A sample of 28 government agencies was randomly selected, representing 25% of the total number of agencies, and a structured telephone interview was administered using an instrument made up of 6 premises. RSEULTS: All (100%) of the agencies had knowledge about the existence of this law, but only 50% had set up and equipped the spaces. Of these, all had a table, a chair, and an electric outlet, 43% had available running water, and 71% provided a refrigerator for milk storage. Fifty three percent of the agencies reported having received followup communications to verify whether they were complying with the law, and 61% reported having a written public policy in support of breastfeeding for working mothers. Only 54% of the agencies stated they had offered some type of orientation to their women employees regarding their breastfeeding rights. CONCLUSIONS: In spite of over two years since the passing of Law 155, the majority of government agencies in Puerto Rico have not complied with its legal dispositions. It is necessary that the responsible entities watch for the satisfactory compliance with this law since working mothers need a secure and accesible place for milk extraction during the working day.

Translation and validation of the breastfeeding self-efficacy scale into Spanish: data from a Puerto Rican population.

Many new mothers discontinue breastfeeding prematurely due to difficulties encountered rather than maternal choice. Research has shown that a significant predictor of breastfeeding duration is maternal confidence. Using self-efficacy theory as a conceptual framework to measure breastfeeding confidence, the Breastfeeding Self-Efficacy Scale (BSES) was developed and psychometrically tested among English-speaking mothers. The purpose of this methodological study was to translate the BSES into Spanish and determine the psychometric characteristics of the BSES in a sample of 100 Puerto Rican women. The psychometric assessment of the original study was replicated including internal consistency, principal components factor analysis, and comparison between contrasted groups. This study is the first to examine the psychometric characteristics of the Spanish-version BSES administered in-hospital and provide further evidence of the reliability and validity of the instrument.

Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux.

Infants with gastroesophageal reflux disease (GERD) who are breastfed have significantly shorter clinical episodes of the condition than artificially fed infants. The purpose of this study was to identify the knowledge about the benefits of breastfeeding in mothers of babies 0-12 months of age with gastroesophageal reflux. A non-probabilistic sample was taken among patients from various private radiological centers. Sixty mothers completed a self-administered questionnaire, with a median age of 26 years and an educational level of 14 years. Seventy one percent breastfed their last baby, but only 18.6% practiced exclusive breastfeeding. The pediatrician suggested formula to 53.3% of the mothers, and 64% of the mothers were told to combine breast milk with vegetables as treatment for the GERD. Inadequate knowledge about the benefits of breastfeeding was exhibited by 27% of the mothers. Mothers of infants with GERD need education on the importance of breastfeeding. Further research is necessary on the factors which impact the duration of breastfeeding in this population.

Profile of calls to a breastfeeding clinic information and help telephone line

Breastfeeding mothers need orientation and help in order to succeed with breastfeeding. Lack of support from health professionals and societal barriers result in a median duration of breastfeeding in Puerto Rico of only 3 weeks. A telephone warm line at our breastfeeding clinic tries to provide some much-needed support and orientation. The purpose of this study was to determine the principal reasons for calls to the warm line and the action taken by the counselor. Five hundred and thirty three calls were received in a 4-month period. They were handled by certified lactation educators who gathered demographic and feeding information from the mother and registered the action taken. Descriptive analysis was used with crosstabs tables and multi-response analysis; chi-square test was used to establish the association between variables. 78.7 of callers were breastfeeding fully, while 21.3 were breastfeeding partially or formula feeding, 62.8 of the babies were 2 months old or less. 68.8 of the calls originated in the metropolitan San Juan area. The source of the referral was family/friend in 64.2 of calls, while only 9.8 of the callers were referred by a physician, 3.0 by hospital personnel and 2.0 by other health care providers. Significant differences between full breastfeeders and partial or artificial feeders were found in calls related to position (p = 0.01), engorgement (p = 0.04), breast refusal (p = 0.001), product information (p = 0.02), medications (p = 0.009), breastmilk management and storage (p = 0.001), and relactation (p = 0.02). Actions taken by the counselor included orientation, referral to breastfeeding specialist physician and referral to breastfeeding support groups or classes. Results indicate that more active promotion of referral to breastfeeding support groups or classes is warranted since this action was taken in only 14.5 of fully breastfeeding mothers and 12.6 of partial breastfeeding or formula users. Promotion of the warm line among physicians, hospitals and other health care professionals is also needed.

The management of labor and delivery and its implications for breastfeeding

The main professional organizations of obstetrical and pediatric care providers in the United States and Puerto Rico have issued official position papers in favor of breastfeeding. Routine labor and delivery practices, however, constitute frequent barriers for the initiation, type and duration of breastfeeding. Many of these practices, moreover, lack the scientific basis to justify their routine use. We analyze in this article some of the most common obstetrical practices and their impact on breastfeeding.

Factores asociados al inicio, tipo y duración de la lactancia materna entre participantes y no participantes a charla prenatal de educación en lactancia materna de una institución hospitalaria / Factors related to initiation, type and length of breast feeding among participants and non-participants in prenatal breast feeding education at a local hospital

The objective of this study was to determine the factors associated to initiation, type and duration of breastfeeding among participants and non-participants in prenatal breastfeeding classes at a local hospital (n = 153). Pre-experimental study design was used. The participants of the study were selected by simple systematic random sampling. Median age of participants was 28 years and 85 percent were married at the moment of the interview. 88.9 percent began to breast feed at some time and of these 32 percent breastfed for six months. Average number of school years completed by participants was 15.1 with a standard deviation of 1.9 years. The inferential results reflected statistical association between participation in prenatal breastfeeding classes and the initiation, type and duration of breastfeeding. Multiple regression results indicate a positive relationship between duration of breastfeeding and participation in breastfeeding support groups, after controlling for all factors of the conceptual model. The results of this study give support for hospital and community initiatives for increasing the incidence of breastfeeding and for extending the duration of breastfeeding. It is further recommended that continued education courses be offered to health professionals on breastfeeding techniques

Ginecólogos-obstetras y pediatras: conocimientos y experiencia hacia la lactancia materna / Gynecologists-obstetricians and pediatricians: knowledge and experience concerning breast feeding

The objective of this study was to identify the level of knowledge and the experience towards breastfeeding of medical personnel (obstetricians and pediatricians) in two private hospitals in Metropolitan San Juan, Puerto Rico. An exploratory research design was used for the study. The studied population consisted of obstetricians and pediatricians practicing in those hospitals. The sample was non-probabilistic and was selected according to availability for participation among the physicians who visited those hospitals in June 1997. The sample was made up of 55 physicians (29 pediatricians and 26 obstetricians). Descriptive statistics, crosstab tables, chi square and Fisher Exact tests were used to establish association between the physician's specialty and his/her knowledge and experience on breastfeeding. It was found that both the pediatricians and the obstetricians studied had lack of knowledge in areas related to breastfeeding and little practical experience in the management of breastfeeding