Eight studies on my reading list (Summer 2016, part 2)

5354645257_a5a03aac13We’re catching up with some recent breastfeeding research studies today! This is the second part of a post that I’ve written because my reading pile has got too high and I’m decluttering and sharing a whole load of studies that you might like to look at. (You can see the first part of this post here). The four that I’m sharing today are all linked with breastfeeding 😀


5. The portrayal of infant feeding in British women’s magazines: a qualitative and quantitative content analysis.

The results of this study aren’t going to be big news to anyone who’s been interested in birth and breastfeeding for more than five minutes, but I find studies like this one to be really useful as starting points for discussion with women and families. That’s because they can provide a springboard for discussing the negative effects of the media on our perceptions and experiences of pregnancy, birth, breastfeeding and our bodies. Sometimes, it can be easier to raise such issues indirectly by sharing and discussing research like this than by tackling it head-on.

Background: Exclusive breastfeeding is the best start an infant can receive. However, in many high-income countries breastfeeding rates are low and this may be a reflection of social norms which in turn may be influenced by the media. This study therefore explored the portrayal of infant feeding in women’s general interest magazines.

Methods: The five top selling women’s weekly magazines in Britain and Ireland for 2013 over a 4-month period were included. A quantitative and qualitative content analysis was conducted for both written and visual content.

Results: In 58 magazines, there were 90 references to infant feeding with an average of 1.5 (range: 0–5) per magazine. Breastfeeding and formula feeding references were present in equal number and both were predominantly portrayed positively. There was only 1 visual representation of breast feeding compared with 11 of bottle feeding. Potential drivers for breastfeeding included its role in post-pregnancy weight loss and celebrity endorsement while family routine, the role of males in the house and concerns about adverse health effects were identified as barriers to breastfeeding.

Conclusion: An improvement in visual representations of breast feeding and factual information in women’s weekly magazines may be helpful in re-defining social norms regarding infant feeding.

O’Brien E, Myles P, Pritchard C et al (2016). The portrayal of infant feeding in British women’s magazines: a qualitative and quantitative content analysis. Journal of Public Health. DOI: 10.1093/pubmed/fdw024


6. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum

Again, probably not completely unexpected news to those who help women breastfeed, but interesting all the same, because research like this can help us see where we might need to target our efforts. It also illustrates, though, how very complex this area is and that it’s not just about physical issues. I am left wondering whether similar results would be found in other areas, which might have different practices and levels of support?

Background: The caesarean section (c-section) rate in Canada is 27.1 %, well above the 5–15 % of deliveries suggested by the World Health Organization in 2009. Emergency and planned c-sections may adversely affect breastfeeding initiation, milk supply and infant breastfeeding receptivity compared to vaginal deliveries. Our study examined mode of delivery and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum.

Methods: The All Our Babies study is a prospective pregnancy cohort in Calgary, Alberta, that began in 2008. Participants completed questionnaires at <25 and 34–36 weeks gestation and approximately 4 months postpartum. Demographic, mental health, lifestyle, and health services data were obtained. Women giving birth to singleton infants were included (n = 3021). Breastfeeding rates and difficulties according to mode of birth (vaginal, planned c-section and emergency c-section) were compared using cross-tabulations and chi-square tests. A multivariable logistic regression model was created to examine the association between mode of birth on breastfeeding duration to 12 weeks postpartum.

Results: More women who delivered by planned c-section had no intention to breastfeed or did not initiate breastfeeding (7.4 % and 4.3 % respectively), when compared to women with vaginal births (3.4 % and 1.8 %, respectively) and emergency c-section (2.7 % and 2.5 %, respectively). Women who delivered by emergency c-section were found to have a higher proportion of breastfeeding difficulties (41 %), and used more resources before (67 %) and after (58 %) leaving the hospital, when compared to vaginal delivery (29 %, 40 %, and 52 %, respectively) or planned c-sections (33 %, 49 %, and 41 %, respectively). Women who delivered with a planned c-section were more likely (OR = 1.61; 95 % CI: 1.14, 2.26; p = 0.014) to discontinue breastfeeding before 12 weeks postpartum compared to those who delivered vaginally, controlling for income, education, parity, preterm birth, maternal physical and mental health, ethnicity and breastfeeding difficulties.

Conclusions: We found that when controlling for socio-demographic and labor and delivery characteristics, planned c-section is associated with early breastfeeding cessation. Anticipatory guidance around breastfeeding could be provided to women considering a planned c-section. As well, additional supportive care could be made available to lactating women with emergency c-sections, within the first 24 hours post birth and throughout the early postpartum period.

Hobbs AJ, Mannion CA, McDonald SW et al, (2016). The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum BMC Pregnancy and Childbirth 16:90.


7. Observation of skin-to-skin contact and analysis of factors linked to failure to breastfeed within 2 hours after birth.

Here’s a really useful study which can tell us a lot about how we can do better. Not that many of us don’t already know this, or (at least in the UK) spend our days being incredibly frustrated with the system that prevents us from giving appropriate care to women and babies, but it can be useful to have the evidence to back that up. It can also be useful to have evidence which shows us where we can target the time and energy that we do have. In some settings it is incredibly difficult, as a health care professional, to be able to create the space for families to have this length of time skin-to-skin. But this study highlights the importance of that and shows us where change might make a positive difference.

Background: Successful breastfeeding at birth seems to be associated with skin-to-skin contact between mother and newborn and newborn suckling, both within the first 2 hours of life. In practice, knowledge about the number and cause of interruptions of this contact has to be increased.

Objective: To measure the actual time of skin-to-skin contact in the first 2 hours after birth, study the events that occur during this period, and search for factors linked to failure to breastfeed.

Materials and Methods: Thirty women wishing to breastfeed gave their consent for us to observe and analyze the first 2 hours of the baby’s life during skin-to-skin contact.

Results: Mean total duration of skin-to-skin contact for the 30 newborns during the first 2 hours was 90.4 ± 25.0 minutes; 17 (56.7%) were interrupted at least twice during this time, mainly for neonatal care. The first interruption took place before the first breastfeed in 60% of cases. Mean time before the first breastfeed was 44.6 ± 21.1 minutes. Seven infants did not breastfeed in the first 2 hours (23.3%). The factors linked to this failure were nulliparity, lower umbilical arterial pH at birth, and early interruptions in skin-to-skin contact. Among them, only early interruptions of skin-to-skin contact appear to be modifiable.

Conclusion: In the first 2 hours of life, early interruptions of skin-to-skin contact should be discouraged as they reduce the chances of early breastfeed.

Perrine R, Pierre-Emmanuel Z, Thameur R et al, (2016). Observation of skin-to-skin contact and analysis of factors linked to failure to breastfeed within 2 hours after birth. Breastfeeding Medicine 11(3):126-32.


8. ‘This little piranha’: a qualitative analysis of the language used by health professionals and mothers to describe infant behaviour during breastfeeding.

I’ve saved my favourite til last! I will admit that I am quite partial to studies which teach me something before I’ve even read further than their title, so this one is right up my alley! I don’t think I had previously heard the phrase that the authors have used in the title of this study – or perhaps I had … it can be hard to remember – but it gives one a sense before even starting to read of what the message is going to be. And even though many of us have known for years that our language can affect women’s and families’ experiences, it’s still all too easy to repeat words and phrases that we have picked up from others around us and never had the time or opportunity to question.

Exclusive breastfeeding for the first 6 months of life offers the recommended best start in the life for a newborn baby. Yet, in Australia only a small number of babies receive breast milk exclusively for the first 6 months. Reasons for the introduction of formula milk are multi-factorial including access to appropriate support and the woman’s experience of breastfeeding. The language and practices of health professionals can impact upon how a woman feels about breastfeeding and her breastfeeding body. One aspect of breastfeeding support that has had scarce attention in the literature is the language used by health professionals to describe the behaviour of the breastfeeding infant during the early establishment phase of breastfeeding. This paper reveals some of the ways in which midwives, lactation consultants and breastfeeding women describe the newborn baby during the first week after birth. The study was conducted at two maternity units in New South Wales. Interactions between midwives and breastfeeding women were observed and audio recorded on the post-natal ward and in women’s homes, in the first week after birth. The transcribed data were analysed using discourse analysis searching for recurring words, themes and metaphors used in descriptions of the breastfeeding baby. Repeated negative references to infant personality and unfavourable interpretations of infant behaviour influenced how women perceived their infant. The findings revealed that positive language and interpretations of infant breastfeeding behaviour emerged from more relationship-based communication.

Burns E, Fenwick J, Sheehan A et al (2016). ‘This little piranha’: a qualitative analysis of the language used by health professionals and mothers to describe infant behaviour during breastfeeding. Maternal and Child Nutrition 12(1):111-24.


photo credit: hello, kitty via photopin (license)

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