[Handling of the breast in breast feeding--with special reference to the effects of a breast pump].
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Maternal serum prolactin (PRL) levels were evaluated in patients having contraction stress tests (CST) by nipple stimulation. Of 79 CSTs, 14 failed and 65 were successful. Poststimulation PRL levels in failed cases were significantly lower than those in gestational age-matched successful cases, despite longer duration of nipple stimulation in the failed cases.
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Breast feeding of premature, new-born babies is often difficult when they become sick and are transferred to a children's hospital. The mother's milk should be collected and provided to the child without a loss of quality or too high a bacterial count which could endanger his health. We collected 113 samples of milk using electric vacuum breast pumps and then determined the bacterial contamination. In most cases there was evidence of bacteria normally found on the skin although more than 10(5)/ml of these bacteria were found in only 11.5% of the samples. As potentially pathogenic germs gram-negative bacilli, beta-hemolytic Streptococci Group B and Staphylococcus aureus were found. The electric pumps were cleaned with two different methods: the usual technique (Series I: 41 samples) and second, sterilization or replacement of the various external pump components between the collection of individual milk samples (Series II: 72 samples). The total of bacteria was considerably reduced by these additional hygienic measures; 62.5% of the samples could now be given to the children unpasteurized whereas the former figure was only 29.3%. On the other hand there was no decrease in the number of milk samples containing either beta-hemolytic Streptococci (Group B) or more than 10(5)/ml bacteria normally found on the skin.
The breast-feeding patterns of 146 women who initiated breast-feeding during their hospital stay were evaluated to determine whether those women who received a hospital discharge package containing a manual breast pump breast-fed their infants for a longer period of time than did women who received a discharge package containing an infant formula. Women were randomly assigned to receive either a specially prepared pack containing a manual breast pump but no infant formula or a commercially available infant formula package. The women were interviewed in the hospital and by computer-assisted telephone interviews at 2, 4, 6, and 8 weeks postdischarge. Information obtained included infant-feeding practices, sociodemographic characteristics, and attitudinal data. Follow-up interviews were completed for nearly 85% of eligible women at each time period. Women who received a discharge pack containing a breast pump but no infant formula continued exclusive breast-feeding for a greater number of weeks (mean = 4.18 weeks) than did women receiving infant formula in their discharge package (mean = 2.78 weeks) (P less than .05). Also, women who indicated that ease of nighttime feeding was an important consideration were more likely to breast-feed over the entire 8-week period if they received the breast pump rather than infant formula (P less than .05). The conclusion is that an easily implemented, low-cost intervention, the inclusion of a breast pump in discharge packages, may increase the duration of breast-feeding.
Support for breastfeeding mothers after they leave the hospital is often inadequate in low-income, inner-city areas where few resources are available. In becoming a Baby-Friendly Hospital, inner-city Boston Medical Center established a breastfeeding telephone support line to overcome this discrepancy. Records of support line calls for the first 5 years of operation were reviewed to record the level of need and determine reasons for use. A total of 1959 calls for 2482 reasons were received between January 1999 and December 2003. The most common reason for calling was "need help obtaining a breast pump" or "need information about breast pumps" (44%; 1096/2482), followed by "breast issue" (7%; 181/2482) and "milk supply question" (7%; 167/2482). The results indicate that inner-city women seek breastfeeding support and demonstrate a substantial need for breast pumps. These findings suggest that the lack of breast pumps may be a barrier to continued breastfeeding for inner-city breastfeeding women.
OBJECTIVE: Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. METHODS: Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. RESULTS: PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (</=19 and 20-24 years old), those with no college (less than high school and high school only), unmarried, and black women (see Table 1). The smallest increases during this period were among older women (30+), those with more than a high school education, and women who were white, Hispanic, or from other ethnic or racial groups. The PRAMS data (1993-1996) generally display similar results, but the pattern by marital status demonstrated larger increases for married women than for unmarried women.
This survey of 567 women reports 676 mother-infant experiences with maternal employment and breastfeeding. Timing of return to employment and number of daily hours worked, rather than type of job, influenced when babies weaned. Timing of return to work had a more negative effect than the number of hours worked. Half of the respondents provided only human milk for missed feedings. Mothers who used breast pumps or hand-expressed their milk were more likely to nurse longer than women who did not pump their breasts at times of missed feedings. American Academy of Pediatrics guidelines regarding recommended timing of solid foods and weaning after the first year were followed by many employed breastfeeding mothers. Breastfeeding is possible following maternal return to employment.
We have investigated the role of endogenous opioid peptides in the release of oxytocin (OT) in response to breast feeding and breast stimulation in humans. Five breast feeding women were studied on two separate occasions within 4 weeks of delivery. Saline or naloxone, 4 mg bolus and 6 mg/h, was administered intravenously, in random order. Blood samples were taken at regular intervals. In the saline-infused group OT rose from a baseline of 1.1 +/- 0.1 pmol/l (mean +/- SEM) to a peak of 7.0 +/- 0.9 after 6 min, and in the naloxone-infused group from 1.0 +/- 0.1 pmol/l to 5.8 +/- 1.3 (P less than 0.05). There were no significant differences between the two groups at any time point. Plasma vasopressin (AVP) did not change. In the second study six women in the luteal phase of the menstrual cycle were investigated on two occasions at least 48 h apart. They were similarly infused with either naloxone or saline in random sequence. A mechanical breast pump provided breast stimulation. In saline-infused women OT levels rose from a baseline of 1.0 +/- 0.1 pmol/l (mean +/- SEM) to a peak of 3.0 +/- 1.1 (P less than 0.05) after 6 min, and in naloxone infused women from 1.1 +/- 0.1 pmol/l to 3.0 +/- 1.4 (NS). There were no differences in OT between the groups. AVP did not change. We conclude that endogenous opioid peptides do not modulate OT release during breast feeding or breast stimulation in women.
The purpose of this study was to identify if special breast cleansing before breast pumping would have an affect on lowering bacterial colony counts of cultured breast milk. Sixty-five women whose infants were being cared for in a NICU and who wished to pump their breasts for future breast milk feedings were randomly assigned to one of two groups: members of a control group were instructed to wash their hands thoroughly before breast pumping, and members of an experimental group were instructed to wash their hands thoroughly and were given special instructions on breast cleansing. All other breast pumping and milk collection instructions for both groups remained the same. A student's t-test revealed a significant difference between the two groups; women who performed special breast cleansing before breast pumping had significantly lower bacterial colony counts in their cultured breast milks.