Breastfeeding confers immunological, physiological and psychological benefits for the infant and mother as well as social and economic benefits to the nation. The United States Department of Health and Human Servcies (HHS), Healthy People 2020 has established national objectives for the initiation and duration of breastfeeding at 82% initiation, 61% at six months and 34% at one year. In addition, they have set goals for exclusive breastfeeding at 3 months to be 46% and 25% at 6 months of infant's age. Currently breastfeeding initiation is at the highest recorded level of 76.9%, yet significant disparities exist (CDC, 2012). The purpose of this study was to examine the association of acculturation and self-efficacy on breastfeeding behavior of a sample of Hispanic women. Initially the plan was to focus on women from Mexican, Cuban and Puerto Rican countries of origin. However recruitiment goals for only the Mexican population were reached. Two valid and reliable bidimensional instruments were used in addition to collecting contextual information to foster a more comprehensive understanding of the acculturation process. The roles of self-efficacy and social support and their relationship with acculturation measures and breastfeeding behavior was explored. The Non-Hispanic domain subscale of the Bidimensional Acculturation Scale scores were significantly different for those breastfeeding compared to those formula feeding, indicating higher levels of Non-Hispanic domain acculturation associated with not breastfeeding. Acculturation and self efficacy (general and parental) were not found to be related. Breastfeeding outcomes and parental self-efficacy were found to have a significant negative correlation, a finding that was in an unexpected direction, with higher parental self-efficacy associated with decreased breastfeeding intensity. Mixed feeding or Las Dos, is a common finding among Hispanic women especially for the Mexican origin community and exclusivity may not have been perceived as higher value then mixed feeding or formula feeding (Bunik et al., 2006). Rates for exclusive breastfeeding at three months are 33% for both the US as well as for Hispanic/Latino ethnicity (National Immunization Survey, 2007). At six weeks the practice of exclusively breastfeeding (not giving formula) was 17% and this is about half of the 46% goal set for exclusive breastfeeding at three months by (HHS) Healthy People 2020. Of those that were exclusively breastfeeding in the hospital only three were still exclusively breastfeeding at the six week follow up call. This presents a unique opportunity in which targeting Hispanic mothers after discharge may assist in increasing further the rates of exclusive breastfeeding and recommendations are provided.

<p>Syftet med uppsatsen är att försöka förklara vad det är som påverkar tiden som en mamma ammar. För att undersöka vad det är som påverkar tiden som en mamma ammar, har en Zero inflated negative binomial-modell (ZINB-modell) tagits fram. Resultaten visar att det som avgör hur länge en mamma kommer att amma är: Graviditetens längd, mammans ålder, mammans rökvanor under graviditetens sista månader, mammans rökvanor samt mammans nationella ursprung.</p>

Syftet med uppsatsen är att försöka förklara vad det är som påverkar tiden som en mamma ammar. För att undersöka vad det är som påverkar tiden som en mamma ammar, har en Zero inflated negative binomial-modell (ZINB-modell) tagits fram. Resultaten visar att det som avgör hur länge en mamma kommer att amma är: Graviditetens längd, mammans ålder, mammans rökvanor under graviditetens sista månader, mammans rökvanor samt mammans nationella ursprung.

Introduction Statistics show a declining trend despite the many benefits of breastfeeding. Aim The aim was to investigate how new mothers experienced the care associated with childbirth, with focus on breastfeeding. Method The study included mothers who gave birth in a hospital in the middle region of Sweden during 2011, and who responded to an online survey (n≈1000). The present study was based upon answers from the open questions concerning dissatisfaction and suggestions for improvement and have been categorized using content analysis. Results Mothers described failure in several areas, with a negative impact on breastfeeding. Many experienced that they had not been seen and treated like an individual, and that the healthcare staff had been unpleasant, impersonal, ignorant and stressed. Mothers wanted more credit from the staff concerning their own ability and some reported that they had been controlled and ”run over”. They experienced care work as unstructured with failure in both procedures and communication. Lack of staff continuity made it difficult for mothers to feel trust and create a relationship. Furthermore, major failure in information and support was reported. Conclusion Although the majority of mothers were satisfied with the early care after giving birth, the open answers showed several areas in need of improvements, among other things individualized care was requested.

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

Longer breastfeeding durations may enhance cognition and accelerate motor development; motor development, and in particular, crawling, may lead to dramatic changes in cognition. Based on these empirical relations, the hypothesis that crawling mediates breastfeeding duration and cognitive outcome was tested. Specifically, it was hypothesized that longer breastfeeding durations would significantly predict both earlier crawling and higher cognitive scores at 2 years of age, that earlier crawling would also predict higher cognitive scores, and that earlier crawling would account for part of the relationship between longer breastfeeding durations and higher cognitive scores. A sample of 44 full term infants from Winnipeg, Manitoba was followed longitudinally between birth and 2 years of age. Data on breastfeeding duration and crawling were collected through daily parent checklists, with supplemental breastfeeding information obtained via questionnaires. Near the toddlers’ 2nd birthdays, cognitive abilities were assessed with the MacArthur Communicative Development Inventory: Words and Sentences (Fenson et al., 1993) and the Parent Report of Children’s Abilities (Saudino et al., 1998). All 3 key variables were measured on continuous scales, and a mediational analysis based on Baron and Kenny’s (1986) classic approach of 3 regressions was used. Several covariates were considered for inclusion in the regressions, but none reached significance in preliminary tests and thus, were not included. In the first 2 regression analyses, exclusive and partial breastfeeding durations significantly predicted neither cognitive scores (p = .59) nor age of crawling attainment (p = .41). The 3rd regression analysis showed a significant, small-to-medium effect size for earlier crawling attainment predicting higher cognitive scores (p < .05, adjusted R2 = .09). However, crawling onset had no effect on the breastfeeding-cognition link. The overall test of the mediation was inconclusive, due to low power. The significant finding between age of crawling onset and cognitive outcomes at 2 years of age may be due to earlier crawling altering the course of development, to reverse causation whereby more cognitively advanced infants are motivated to crawl sooner, or to a 3rd variable affecting both crawling and cognition. Future research should continue to explore motor and cognitive connections in infant development. / May 2005

This thesis analyzes public “nurse-ins” and breastfeeding activism of the past decade, examining public breastfeeding demonstrations as an example of collective rhetoric in which the individual is empowered in its relation to the masses. The author discusses the potential of collective rhetoric to reintroduce feminist activism at a time dominated by postfeminist discourse. Staged nurse-ins force the public to confront realities of the maternal body; however, the self-proclaimed “lactivists” seldom discuss the inseparable sexuality of the breast and the underlying narrative of “natural” and “good” motherhood. Addressing Foucauldian discursive formations, the author acknowledges that even though the resistant discourse cannot exist outside of the dominant discourses that continue to act upon it, collective demonstrations nevertheless hold the power to disrupt public perception of the maternal body.

Syftet var att beskriva omvårdnaden kring nyfödda barns tillmatning på svenska BB-avdelningar, om föreskrifter följdes och om hänsyn togs till eventuell allergihereditet. Metod: Deskriptiv tvärsnittsstudie med kvantitativ ansats Resultat: Av alla nyfödda barn vid 26 barnkliniker i Sverige vecka 26 år 2009 (n=849) tillmatades 18 % . Moderns bröstmjölk gavs till 16% medan 78 % tillmatades med komjölksbaserad modersmjölksersättning. Den vanligaste orsaken till tillmatning av ersättning var att mammans egen mjölkproduktion inte hade kommit igång (24 %). Andra vanligt förekommande anledningar till tillmatning var lågt blodsocker (18 %) samt sugproblem hos barnen (16 %). Sexton barn tillmatades trots ett blodsockervärde motsvarande &gt;2.2mmol/l. Vad gäller allergiförekomst tillfrågades endast 37 % av barnens föräldrar före tillmatning. Dokumentation om tillmatning fanns noterat i 80 % av barnens journaler. Motsvarande siffra för mammornas journaler var 34 %. Konklusion: Bristfälliga omvårdnadsåtgärder vidtas i samband med tillmatning av nyfödda spädbarn på BB-avdelningar, där allergifrågor ställs i för låg utsträckning. BB-kliniker har varierande referensvärde för vad som räknas som lågt blodsocker. Omvårdnadsbehov för nyfödda barn och deras föräldrar, där förmedlad kunskap om amningens betydelse, tas inte på allvar och oklara riktlinjer skapar förvirring. Föreskrifter och riktlinjer bör följas i större utsträckning an vad denna studie visar.

Amning är viktig ur många aspekter. Om amningen inte fungerar kan det få känslomässiga konsekvenser för den nyblivna modern och anknytningen till barnet kan också påverkas negativt. Tiden för nyblivna mödrar att tillgodogöra sig amningskunskaper och -färdigheter på BB har minskat på senare år då vårdtiden har kortats. Syftet med denna litteraturstudie var att undersöka nyblivna mödrars upplevelse av amningsstöd på BB. Elva vetenskapliga artiklar granskades och bedömdes. Hur nyblivna mödrar upplevde amningsstödet på BB kunde urskiljas i fyra kategorier; Råd och information, Bemötande och praktisk hjälp, Individuell bekräftelse och Stress. När amningsstödet inte motsvarade mödrarnas önskemål, ledde det till känslor av osäkerhet och otillräcklighet. Fortsatt forskning är nödvändig för att ta reda på hur amningsstödet kan förbättras för nyblivna mödrar på BB. Det behövs ett nytt sätt att organisera och arbeta för att vården skall bli mer jämlik, där mödrarna i större utsträckning är delaktiga och ges eget ansvar. / Breastfeeding is important in many aspects. If breastfeeding does not work, it may have emotional consequences for the new mother and attachment to the child may also be adversely affected. The time for new mothers to benefit from breastfeeding knowledge and skills in the maternity ward has declined in recent years when the hospital stay has been shortened. The purpose of this study was to examine new mothers' experiences of breastfeeding support in the maternity ward. Eleven scientific papers were surveyed and evaluated. How new mothers experienced breastfeeding support in the maternity ward were evident in four categories: Advice and Information, Treatment and practical help, Independent confirmation and Stress. When breastfeeding support did not meet their mothers' wishes, it led to feelings of insecurity and inadequacy. Further research is needed to find out how breastfeeding support can be improved for new mothers in the maternity ward. We need a new way of organizing and working in healthcare to be more equal, where the mothers to a greater extent are involved and given responsibility.