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Care for the New-Born: Breastfeeding and Skin-to-Skin Contact
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Perinatal, neonatal och barnkardiologisk forskning)
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breastfeeding is associated with improved health in mothers and children and human milk is especially beneficial for preterm infants. The vast majority of pregnant women in Sweden intend to breastfeed, but breastfeeding rates are suboptimal, with even lower rates for preterm infants.

The overall aim of this thesis was to describe breastfeeding patterns of preterm and term infants and to evaluate an intervention based on the Ten steps to successful breastfeeding on breastfeeding outcomes.

In Paper I, mothers of preterm infants reported large variations in breastfeeding frequencies and patterns. The median breastfeeding frequencies from birth to six months ranged from 10–14 times per 24 hours with the majority practicing on demand breastfeeding.

In Paper II the median daily duration of skin-to-skin contact in preterm infants during the hospital stay was associated with earlier breastfeeding attainment. Infants commenced full breastfeeding at a median postmenstrual age of 35+0 weeks (range 32+1 to 37+5). Breastfeeding duration was shorter than national statistics.

Paper III describes the development and implementation of a breastfeeding support program for term and preterm infants using Intervention Mapping. The method was time-consuming, but allowed for a solid theoretical base, high involvement of stakeholders and was sufficiently comprehensive.

Paper IV included term infants at age two months and their mothers and consisted of a baseline group and intervention group. Mothers reported large variations in breastfeeding frequencies and patterns. Mothers in the intervention group breastfed more frequently, in median 14 times compared to 11 times in the baseline group, and they also practiced on demand breastfeeding to a larger extent. Mothers with exclusive breastfeeding reported higher self -efficacy.

This thesis provides a better understanding of breastfeeding patterns in preterm and term infants and it demonstrates that breastfeeding frequencies and on demand breastfeeding can be influenced with improved breastfeeding support. For preterm infants, breastfeeding attainment is facilitated by skin-to-skin-contact and they have the capability to breastfeed at a low postmenstrual age. This thesis also demonstrates a possible link between breastfeeding patterns and mothers’ ability to interpret infant cues. Intervention Mapping is a useful tool in the development of breastfeeding support programs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. , p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1692
Keywords [en]
Breastfeeding, Lactation, Human Milk, Newborn, Infant, Preterm Infant, Kangaroo Mother Care, Mother-infant interaction, Parent-Child Relations, Object Attachment, Self Efficacy, Implementation Science, Quality of healthcare, Quality improvement
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-421577ISBN: 978-91-513-1039-8 (print)OAI: oai:DiVA.org:uu-421577DiVA, id: diva2:1476228
Public defence
2020-12-03, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2020-11-12 Created: 2020-10-14 Last updated: 2021-01-22
List of papers
1. Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks
Open this publication in new window or tab >>Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks
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2015 (English)In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 31, no 3, p. 377-385Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.

OBJECTIVE:

This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.

METHODS:

As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions.

RESULTS:

In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8).

CONCLUSION:

Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.

National Category
Clinical Medicine Pediatrics
Identifiers
urn:nbn:se:uu:diva-254708 (URN)10.1177/0890334415586406 (DOI)000358070300010 ()25956792 (PubMedID)
Note

This study was supported by grants from the Regional Research Council in the Uppsala-Orebro region, Uppsala County Council, and Uppsala University Funds.

Available from: 2015-06-10 Created: 2015-06-10 Last updated: 2020-10-14
2. Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants
Open this publication in new window or tab >>Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants
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2016 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, p. 783-789Article in journal (Refereed) Published
Abstract [en]

AIM:

This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored.

METHODS:

A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28+0 to 33+6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records and follow-up questionnaires were filled in by parents.

RESULTS:

The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35+0 (32+1 to 37+5) weeks of postmenstrual age and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p<0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding.

CONCLUSION:

A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.

Keywords
Breastfeeding duration; family-centred care; human milk; infant growth; Kangaroo mother care
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-289173 (URN)10.1111/apa.13431 (DOI)000378565100018 ()27100380 (PubMedID)
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2020-10-14
3. Development and implementation of a breastfeeding support program using Intervention Mapping
Open this publication in new window or tab >>Development and implementation of a breastfeeding support program using Intervention Mapping
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background and objectives:Breastfeeding is associated with reduced morbidity and mortality in both mothers and infants. Our aim was to develop and implement a complex intervention program in order to increase the rates of breastfeeding and to optimize clinical practice.

 

Methods:The six-step process of Intervention Mapping was used: (i) needs assessment, (ii) defining performance objectives, (iii) selecting methods and applications, (iv) designing the program, (v) planning for program implementation, and (vi) planning for program evaluation. The Ten Steps to Successful Breastfeeding in Baby Friendly Hospitals, which is considered a gold standard, was used as a starting point to define best practice.

 

Results: The process and the evidence for the selection of key objectives and strategies of the intervention can be summarized as follows: (i) increase health care professionals’ competence in breastfeeding support, (ii) increase the mother’s breastfeeding self-efficacy through information and better support, and (iii) improve routines and practices in health care that may impact breastfeeding.

 

Conclusions:The Intervention Mapping approach was useful in developing a 

breastfeeding implementation program and ensuring the development was sufficiently comprehensive, accepted in the clinical context, efficient, and context-specific, with a solid theoretical base.

Keywords
Exclusive Breastfeeding, Health Promotion, Implementation Science, Kangaroo Mother Care, Parenting, Skin-to-Skin Contact
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-421575 (URN)
Available from: 2020-10-09 Created: 2020-10-09 Last updated: 2020-10-14
4. A breastfeeding support program changed breastfeeding patterns but did not affect the mothers' self-efficacy in breastfeeding at two months
Open this publication in new window or tab >>A breastfeeding support program changed breastfeeding patterns but did not affect the mothers' self-efficacy in breastfeeding at two months
2020 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 151, article id 105242Article in journal (Refereed) Published
Abstract [en]

Background: Even though the biological norm in humans is frequent on demand breastfeeding,sparse feeding intervals have become the cultural norm in most Western countries due to a history of on schedule breastfeeding. This discrepancy between the biological basis and the culturally driven practice continues to interfere with women’s ability to breastfeed.

Aim: Our aim was to describe breastfeeding patterns in 2-month-old infants before and after the implementation of a breastfeeding support program. A secondary aim was to investigate the relationship between breastfeeding patterns and the mother’s self-efficacy in breastfeeding.

Methods: The study had a baseline/intervention design and was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding program. The larger project included breastfeeding training for health care professionals and provision of breastfeeding information to parents, including information about on demand breastfeeding. Data were gathered viabreastfeeding diaries (n=79 mothers from each group) and the Breastfeeding Self-efficacy Scale–Short Form (n=83 in the baseline group and n=79 in the intervention group).

Results: On demand breastfeeding patterns were more common in the intervention group (97.5%) than in the baseline group (74.7%) (p<0.001), and breastfeeding sessions were more frequent in the intervention group (a median of 14 times per 24 hours versus 11 times in the baseline group; p=0.026). Self-efficacy in breastfeeding did not differ between the groups, but was higher in mothers with exclusive breastfeeding.

Conclusions: Knowledge about infants’ breastfeeding behavior can strengthen on demand breastfeeding. Exclusive breastfeeding is associated with higher self-efficacy.

Keywords
human milk, infant feeding patterns, lactation management, mother-infant dyad
National Category
Pediatrics Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-421576 (URN)10.1016/j.earlhumdev.2020.105242 (DOI)000595858500002 ()33137580 (PubMedID)
Funder
Gillbergska stiftelsen
Available from: 2020-10-09 Created: 2020-10-09 Last updated: 2021-02-12Bibliographically approved

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