Breastfeeding is considered to be the optimal choice of infant feeding methods, yet the rates of breastfeeding are consistently lower than national recommendations despite efforts to reverse this trend. Designing effective interventions to increase breastfeeding requires a thorough understanding of the women who choose to breastfeed their infants as well as those who do not choose this infant feeding method. In order to determine which demographic factors predicted breastfeeding in the early postpartum period in Utah women, 600 'intercept interviews' were conducted in the spring and early summer of 2007. Women included in the study were 18 years or older and had an infant who was 6 weeks to 1 year old. Participants were 18-42 years old, and reported having between one and six children. Participants were recruited from public areas in Salt Lake City, such as shopping malls, parks, and civic venues. Information from 588 interviews was included in the analysis. Data analysis was conducted using STATA 9.0. Univariate analysis was first conducted to determine if a significant relationship existed between breastfeeding at 6 weeks postpartum and the demographic factors. Univariate analysis determined that a statistically significant (p < 0.05) relationship existed between breastfeeding in the early postpartum period and the following demographic factors: age, marital status, WIC participation, maternal education level, and maternal employment. Univariate analysis failed to find a statistically significant relationship between breastfeeding in the early postpartum period and parity. Next, simple logistic regression was conducted to determine the strength and direction of any significant relationship. Finally, multiple logistic regression with backward elimination was performed to determine whether factors differed across age strata. Multiple regression analysis found that, when stratified by age, maternal education was found to be significant in both the younger (18-25 years) age group (OR = .56; 95% CI = .43, .71) and the older (26-42 years) age group (OR = 1.54; 95% CI = 1.28, 1.86). The effects of education on breastfeeding at 6 weeks postpartum differed across age groups in a statistically significant way, as determined by a chi square test (p = 0.00). More research is needed to fully understand the relationship between demographic factors and breastfeeding in the early postpartum period.

Thesis (M.S.)--Boston University

Breast milk is well recognized as the best natural food for infants and is also known to provide immediate and long-term health benefits for infants. According to the Baby- Friendly Hospital Initiative Hong Kong Association, the breastfeeding initiation rate in Hong Kong has been continuously increasing. For duration of breastfeeding, World Health Organization recommends exclusive breastfeeding for six months and the introduction of complementary food should start since the age of two. Despite active promotion of breastfeeding up to 6 months, the exclusive breastfeeding rate is still low and women in Hong Kong generally stop breastfeeding within the first few months. The Department of Health in Hong Kong facilitates a supportive environment in all Maternal and Child Health centres to promote breastfeeding. To support mothers exclusively breastfeed for the first six months, a structured individualized lactation counseling and support is worth to implement when mothers are discharged from hospital around 48 hours and transfer to primary care. The individualized lactation counseling provides latching technique to ensure proper attachment and positioning to prevent early complications at the early postnatal. It also continues to follow up until 1-to-2 weeks after delivery. The objective of this study is to evaluate the effectiveness of the individualized professional lactation counseling and support at early postnatal periods to prolong the duration of breastfeeding. Eight studies were identified after comprehensive literature review and the quality of these studies was assessed. An evidence-based guideline was developed based on the analyzed research findings. The implementation and evaluation of the proposed guideline were compiled in this translational research. An evidence-based guideline for providing individualized lactation counseling and support was developed to help health professionals to provide competent and effective breastfeeding counseling to mothers. The purpose of the guideline is to encourage mothers to breastfeed up to six months. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Breast milk provides optimal nutrition for babies and exhibits short and long-term health benefits for mothers and babies. Comparing the breastfeeding figures worldwide, Hong Kong has lower breastfeeding rates compared with other developed countries. Clinically and locally, inadequate skill support from nurses decreases breastfeeding rates. This thesis introduces evidenced-based guidelines of breastfeeding focused on skill training for improving duration and exclusiveness of breastfeeding. Based on available evidence, the guidelines aim to improve breastfeeding rates. The guidelines focus on skill training (position and attachment) as major component. Transferability and feasibility to apply the guidelines clinically was assessed. Lastly, an implementation plan was discussed. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Breastmilk is the most natural and complete nutrition for infants, and breastfeeding incurs numerous benefits for both infants and mothers. The World Health Organization recommends that mothers exclusively breastfeed their infants for six months and continue breastfeeding for up to two years of age and beyond. More than 80% of Hong Kong mothers now initiate breastfeeding. However, overall breastfeeding duration remains short and rates of exclusive breastfeeding are low. Premature weaning is influenced by multiple factors, and mothers require additional support from healthcare professionals to overcome various lactation difficulties in the early postpartum period. This study aimed to evaluate the effect of two postnatal professional support interventions on the duration of any and exclusive breastfeeding. We conducted a cluster randomized controlled trial to evaluate the efficacy of in-hospital support and post-discharge telephone support on breastfeeding outcomes among first-time mothers in Hong Kong. Seven hundred and twenty two mother-infant pairs with uncomplicated, full-term pregnancies were recruited from the postnatal units of three large public hospitals. With the hospital as the unit of randomization, participants were allocated to standard care (n=263), in-hospital support (n=191), or post-discharge telephone support (n=268). Mothers in the in-hospital group were given three individualized breastfeeding support sessions during the postnatal hospitalization, with two sessions given in first 24 hours after birth and one the following day, providing lactation knowledge and instructions on breastfeeding techniques. Participants in the telephone group were provided with weekly 30-minute breastfeeding counseling and support sessions for the first four weeks after delivery, with first contact initiated within 72 hours after discharge. The primary study outcomes were the prevalence of any and exclusive breastfeeding at one, two and three months postpartum. Seven hundred (97%) participants completed the six-month follow-up, while eleven had partial follow-up and eleven could not be contacted. The rates of any and exclusive breastfeeding were higher among participants in the two intervention groups at all follow-up points when compared with those who received standard care. Participants receiving the telephone support were significantly more likely to continue any breastfeeding at one month (76.2% vs. 67.3%; OR=1.63, 95% CI 1.10-2.41) and two months (58.6% vs. 48.9%; OR=1.48, 95% CI 1.04-2.10), and to be exclusively breastfeeding at one month (28.4% vs. 16.9%; OR=1.90, 95% CI 1.24-2.91). Participants in the in-hospital support group were also more likely to be breastfeeding at all time points in the first six months but the effect was not statistically significant. Early professional breastfeeding support, especially weekly telephone counseling, significantly increased the rates of any and exclusive breastfeeding in the early postpartum period and significantly increased overall breastfeeding duration in the first six months among first-time mothers. Additional postnatal professional support when given to breastfeeding mothers on a one-to-one basis can improve breastfeeding outcomes. While hospital practices need to be strengthened to further promote and support breastfeeding, more well-designed trials are required to determine the most effective mode and intensity of intervention that improves the longer-term breastfeeding rates. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing

In Hong Kong, while around 85% of mothers choose to breastfeed their infants, most discontinue within the first one to two months postpartum. This indicates that there is room for improving the current breastfeeding education. A randomized controlled trial was conducted to evaluate the effectiveness of a professional one-to-one antenatal breastfeeding support and education intervention on the exclusivity and duration of breastfeeding. A total of 469 primiparous women who attended the antenatal clinics of two geographically distributed public hospitals in Hong Kong were randomized to receive either standard antenatal care or a one-to-one antenatal breastfeeding support and education session. The primary outcome was the prevalence of exclusive breastfeeding at 6 weeks postpartum. Secondary outcomes were the prevalence of exclusive breastfeeding at 3 and 6 months postpartum, as well as the overall duration of any and exclusive breastfeeding across the first 6 months postpartum. The study had a least 80% power to detect a 50% increase in the rate of exclusive breastfeeding at 6 weeks postpartum. The exclusive breastfeeding rate in the intervention group was 37.8% at 6 weeks postpartum compared with 36.4% in the standard care group (p=0.77; 95% Confidence Interval (CI) -0.08, 0.11). There were no significant differences between the two treatment groups in exclusive breastfeeding rates at 3 and 6 months or in in the overall duration of any (Hazard Ratio (HR) =1.11; 95% CI 0.88, 1.40) or exclusive breastfeeding (HR=0.96; 95% CI 0.79, 1.17). In a setting with a high breastfeeding initiation rate, one-to-one antenatal breastfeeding support and education did not increase the exclusivity or duration of breastfeeding. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

This thesis aimed to provide an integrated model of infant feeding, centred on women's experiences. Two studies were employed in order to meet this aim. Firstly, a questionnaire-based longitudinal study within a Social Cognitive framework was carried out in order to understand the internal and external processes involved in the infant feeding experience. Eighty-five first time mothers participated in this study. Participants were assessed at three stages; once during pregnancy, once at six to eight, and again at four to six moths postpartum. The results of the longitudinal study supported the use of the Social Cognitive framework, and more specifically the applications of both the Theory of Reasoned Action (Ajzen &amp; Fishbein, 1980), and Self-Efficacy Theory (Bandura, 1977). Further, analysis revealed support for the conceptualisation of Social Support in this study, and enhanced understanding of the role of external variables. The second study contained within this thesis was a qualitative interview-based study of the infant feeding experiences of eight participants of the longitudinal study who volunteered to be interviewed. The combination of the results of the quantitative longitudinal study and the qualitative study gave rise to a reconceptualisation of infant feeding encompassing three phases; the decision phase, the initiation phase, and the maintenance phase that were formed and are themselves guided by internal and external processes based on women's individual experiences. It is proposed that this integrated model can be used as a platforn1 for the furthering of women-centred theoretically based infant feeding research, and furthermore, the development of women-centred, evidence-based practice.

The aims of this study were:-identify breast feeding problems mothers have experienced-formulate theories about what could be done to improve breastfeeding outcomes-consider if it is practicable for the health care system to implement these changes-explore what strategies might be developed to improve breastfeeding outcomes beyond the health care system.

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 45-54)

Thesis (M.Med.Sc.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 47-53). Also available in print.