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Background: Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide quality improvement collaborative that elected to design and develop a project to address Tennessee's low breastfeeding rates. Purpose: To improve the health of Tennessee infants and mothers by increasing initiation and duration of breastfeeding through systematic implementation of processes with high reliability (> 90%) that promote and support breastfeeding in the delivery setting. Methods: A toolkit was created using the evidence-based practices of the Ten Steps to Successful Breastfeeding and the USBC Toolkit, “Implementing the Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding.” Eleven hospitals across the state of Tennessee are currently participating in the project since the state-wide kick-off in July 2012. Participating hospitals established improvement teams of stakeholders, and began collecting exclusive breastfeeding rates at hospital discharge, according to the Joint Commission Perinatal Core Measure 5 guidelines. After baseline data collection, the centers are implementing one or more of the 10 Steps to Successful Breastfeeding by using rapid Plan-Do-Study-Act (PDSA) cycles. Reliability of implementation is monitored by process measure audits. Web-based data-entry through REDCap provides on-demand run-charts to each individual center. Monthly webinars facilitate sharing of best practices between geographically distant centers, as well as sharing of the state-wide data in aggregate. Each participating center creates a Leadership Report highlighting its recent data on exclusive breastfeeding as well as selected PDSA cycles. Centers also share lessons learned and query participating centers on specific challenges. Additionally centers are invited to attend a face-to-face annual state-wide meeting with nationally recognized experts, as well as two regional workshops per year to share challenges and successes, and to learn quality improvement strategies from the TIPQC Quality Improvement team. Results: Baseline exclusive breastfeeding at discharge according to the Joint Commission criteria was 35% in aggregate. Initial data demonstrate that centers have noted some success in implementing changes in all of the Ten Steps to Successful Breastfeeding. Skin-to-skin care has been markedly increased in several centers, with some centers specifically targeting skin-to-skin care after C-Sections. Centers have also seen increases in rooming-in, staff training, and adoption of a breastfeeding policy. Upstream opportunities have been identified for prenatal education with providers of prenatal care (Step 3). Downstream opportunities have been identified for community support at discharge from the center (Step 10). Baseline data in the first 5 months of the project from over 7000 maternal-infant dyads (approximately 25% of Tennessee births) highlight improvement opportunities on all of the Ten Steps. Conclusions: This project serves as a model for how quality improvement methodologies may be combined with use of distance-learning and web-based data entry and reporting to facilitate implementation of evidenced based practices to increase breastfeeding rates.

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Source: Masters Abstracts International, Volume: 47-01, page: 0343. Adviser: Jacquelyn Slomka. Includes bibliographical references.

Demographic Characteristics And Breastfeeding Confidence Of Mothers Who Choose To Exclusively Breastfeed And Combination Feed Their Infants Subjects were recruited from physicians' offices and public clinics in a metropolitan area (n=71). Fifteen (21%) of the subjects were planning to combination feed while 56 (79%) were planning to exclusively breastfeed. Subjects completed the Maternal Confidence Survey (O'Campo et al, 1992) and provided demographic information. A higher proportion of women planning to exclusively breastfeed were married (p=0.003), Caucasian (p=0.005), and educated beyond the high school level (p=0.04). Subjects in the exclusively breastfeeding group were significantly older (mean age = 26.7) than those in the combination feeding group (mean age = 22.8) (p=0.009). Confidence scores were significantly higher (mean score = 4.7) among women planning to exclusively breastfeed compared to women planning to combination feed (mean score = 4.3) (p=0.04). Results of this study suggest women who intend to combination feed are distinctly different from those who intend to exclusively breastfeed. Women planning to combination feed may benefit from prenatal intervention to enhance breastfeeding confidence. / Department of Family and Consumer Sciences

Typescript. Includes vita and abstract. Includes bibliographical references (leaves 163-169). Also available online in Scholars' Bank; and in ProQuest, free to University of Oregon users.

Indiana University-Purdue University Indianapolis (IUPUI) / Despite clinical recommendations, only 25.8% of infants in the United States are exclusively breastfed at 6 months of age. Breastfeeding policies and communication campaigns exist to support exclusive breastfeeding, and women who use formula report facing stigma and feeling like a failure. Narratives can be used to discern how individuals make sense of experiences related to health, and narrative theorizing in health communication provides a framework of problematics used to explain how individuals construct stories that reveal the tensions between continuity and disruption and creativity and constraint. Individual experiences are often influenced by master narratives such as “Breast is best,” which are phrases that shape our understanding of the world. Because of the negative impact of using formula on maternal well-being, the purpose of this research was to use a narrative framework to analyze the stories of women who used formula in relation to the master narrative of breast is best. Building off of pilot interviews with 22 mothers, semi-structured interviews were conducted with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women perceived formula as shameful and costly. Conversely, they viewed breastfeeding as biologically superior, better for bonding, and a way to enact good motherhood. Current messaging about breastfeeding, particularly for women who intend to breastfeed, may have unintended negative effects when women face a disruption to their breastfeeding journey. In addition, women viewed breastfeeding and formula feeding as in relation to and in opposition to one another, reducing the perceived acceptability of behaviors such as combination feeding. Despite constraints in the master narrative regarding acceptable infant feeding practices, women demonstrated creativity in their individual stories and found formula feeding enabled more equitable parenting and preserved mental health. Practical implications include that organizations promoting exclusive breastfeeding in the United States should move away from framing breastfeeding as an all-or-nothing choice and develop tailored and value-neutral messaging recognizing breastfeeding as a complex psychosocial and biological process.

Submitted in full compliance with the requirements for a Master’s Degree in Technology: Nursing, Department of Community Health Studies at the Durban University of Technology, 2009. / Purpose: Breastfeeding is a key child survival strategy important for the long-term health of both the mother and child. The number of women in paid employment has increased exponentially, yet very few of these women continue breastfeeding as recommended by the World Health Organisation. The purpose of this qualitative study was to identify the factors affecting breastfeeding practices in the workplace. Objectives of the study are to: 1: Describe managers’ attitudes to and knowledge about providing breastfeeding support. 2: Identify mothers’ attitudes towards breastfeeding and the workplace environment. 3: Describe the practices of the breastfeeding mothers in the workplace. 4: Identify factors that influence breastfeeding practices within the workplace environment Method The theoretical frameworks adopted were the Situation- Specific Theory of Breastfeeding and the BASNEF model. The frameworks together with the literature review provided the background which informed this study. The research was a case study of two multi -national companies in Durban, KwaZulu Natal; participants were mothers and managers in the companies. Purposive sampling was used for selecting eight women who participated in the focus groups, two follow up interviews were conducted and five managers were interviewed. Data collection techniques also included a reflexive journal and field observation. After a thorough review of the data, the main themes which emerged were used to guide the discussion and answer the objectives of the study. Results The two companies reflected a scenario of pressures in the workplace environment affecting women’s choices regarding combining work and breastfeeding; societal pressures were dictating acceptable behaviour. Breastfeeding was not a priority for employers, no breastfeeding policy existed. Breastfeeding mothers were isolated and employers and employees were not engaging on the issue. Conclusions and Recommendations Simple enabling factors within the workplace would allow mothers, their infants and employers to enjoy the benefits of supporting breastfeeding in the workplace; this would be a win-win situation. Government, non-governmental organisations and society have a responsibility to overtly protect, support and promote breastfeeding in society and in the workplace.