2010 - International Lactation Consultant Association

2010 PROJECT POSTER ABSTRACTS
THE JOURNEY TO BECOMING A BABY-FRIENDLY HOSPITAL
Rebecca Sue Law, BSN, RN, IBCLC, LCCE, FACCE;
Laura Jane Burnett, RN, BSN, IBCLC; Vicki Lynn Gettel, RN, BSN, IBCLC, LCCE
PO Box 72
Aledo, TX 76008
817-250-5545; beckylaw@texashealth.org
ABSTRACT
The journey to becoming a Baby Friendly Hospital is challenging. Making the Baby Friendly
Hospital Initiative (BFHI) a quality initiative for the thirteen hospitals within this system and
utilizing a team approach allowed three hospitals to attain the designation of Baby Friendly and
also become the first three hospitals in the state of Texas to attain this designation. The
presentation will provide a snapshot of the work required to become a Baby Friendly Hospital.
Strategic planning and addressing challenges to win support and foster change within the
thirteen hospitals will be discussed. This collaborative and supportive process resulted in
breastfeeding policies modeled after the Ten Steps of Successful Breastfeeding as well as other
system policies and practices that strongly support breastfeeding within the organization. Staff
education programs, implementation tools, and other creative ideas will be shared. Cost
effectiveness and cost savings realized when implementing the Ten Steps will be offered.
Discussion of cost analysis and fair market pricing for infant formulas will be presented.
Participants will be offered tips for the promotion of rooming in and scripting for staff that is
supportive of both mother and baby. Execution of successful mock and actual surveys will be
outlined along with proven strategies for sustaining the Baby Friendly philosophy beyond the
survey.
BREASTFEEDING EDUCATION IN CLINICAL AND PUBLIC HEALTH CURRICULA
Brook Colgan, MPH; Miriam Labbok, MD, MPH, FACPM, IBCLC
Carolina Breastfeeding Institute
422 Rosenau Hall, CB #7445
Chapel Hill, NC 27599-7445
919-843-9043; brook@email.unc.edu
ABSTRACT
Background: In an effort to augment breastfeeding education in public health curricula and to
increase the number and quality of International Board Certified Lactation Consultants, the
Carolina Breastfeeding Institute (CBI) has developed a Public Health Certificate in Breastfeeding
as well as a course titled “Clinical Support of Breastfeeding” to serve as a Pathway 2 option of
IBLCE.
Goal(s): To provide public health, medical, and nursing students with advanced training in
breastfeeding protection, promotion and support as called for in the WHO/UNICEF Innocenti
Declaration of 1990 and the US DHHS Blueprint for Action on Breastfeeding of 1999.
Methods: Market research was completed for the Public Health Certificate in Breastfeeding
Program. Following the collection of market research survey results, intense curriculum
development transpired for the certificate program and the clinical course; resulting curricula
was presented to the UNC Gillings School of Global Public Health for approval.
Results: The market research Qualtrics survey obtained 303 completed responses. The market
research findings demonstrate that: • 132 respondents (44%) stated they were interested or

very interested in the proposed certificate • 61 respondents (20%) stated that they would apply
now for the certificate if it were available. The clinical course is currently half-way through the
first semester and feedback will be collected from students for quality improvement. Results
from the course evaluation will be presented.
Conclusion(s): This poster will include a brief presentation of the certificate and clinical course as
well as ideas for additional implementation of breastfeeding in graduate health education and
medical training.
IMPROVING BREASTMILK FEEDING RATES AT DISCHARGE FROM NICU: STAFF
EDUCATION, IMPLEMENTATION AND PARENT EDUCATION
Kathryn G. Banus, BSN, RN, IBCLC;
Mary Beth Blue, BSN, MA, RN, IBCLC; Terri D Dutton, BS, RN, BSN
Northeast Baptist Hospital
21907 Seminole Oaks
San Antonio, TX 78261
210-297-2069; kgbanus@baptisthealthsystem.com
ABSTRACT
Many obstacles to breastfeeding, or maintaining an adequate supply of pumped breastmilk occur
whenever a preterm or term infant is admitted to a NICU. One obstacle that can be ameliorated
through staff intervention is early initiation of breast pumping with massage and manual
expression. Our goal was to improve rates of pump initiation within 6 hours of NICU admission
and to teach parents massage and manual expression. This required multi-level staff education,
management and physician support, and acquisition and ready availability of audio-visual
materials for parent education. We developed a lactation care plan/data sheet for auditing pump
set-up times and collection of feeding-at-discharge statistics. A simple reward system for staff
who assured their patients began pumping within 6 hours was begun. After 1 year of data
collection, system wide results showed a 24% increase in timely pump set up and 33% more
pumps started by nurses rather than lactation consultants. One hospital tracked breastfeeding
rates at discharge. There was an average of 5% increase of NICU babies receiving greater than
50% breastmilk at discharge. An added benefit is a noticeable improvement in nurses’ sense of
responsibility about initiating pumping for NICU moms. With continued early pump initiation and
ongoing staff education, we expect our breastmilk feeding rates at discharge to increase. Using
similar targeted, creative interventions, and with minimal expense, any hospital could improve
their early pump initiation rates and subsequently their breastmilk feeding rates at discharge.
AN EVALUATION OF THE BREASTFEEDING PEER HELPER PROGRAM IN OHIO’S SPECIAL
SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN
Ann Marie Twiggs, RD, LD, IBCLC, CLC;
Jaclyn Young; Elizabeth J Conrey, PhD, RD
Ohio Department of Health
1003 Bryden Road
Columbus, Ohio 43205
614-644-8915; ann.twiggs@odh.ohio.gov
ABSTRACT
Background: Ohio’s Special Supplemental Nutrition Program for Women, Infants and Children
(WIC) is comprised of 75 projects, each serving one to three counties. On January, 2004, 11
projects implemented the Breastfeeding Peer Helper Program (BPHP), which aims to increase

eastfeeding initiation and duration among WIC participants by employing and training women
who have breastfed to promote, support and educate on breastfeeding.
The objectives of this study were to 1) describe program operations, and 2) assess BPHP effects
on initiation rates.
Methods: PH and supervisors completed an online questionnaire on training, employment,
activities and PH demographics. Data on breastfeeding rates and participant demographics came
from the Pediatric Nutrition Surveillance System (PedNSS), the Pregnancy Nutrition Surveillance
System (PNSS) and administrative records. SPSS was used to analyze descriptive data and SAS
to compare breastfeeding rates.
Results: BPHP administration including hours of training (median: 24) ratio of peers to women
participants (range: 1:100 to 1:1300), rate of pay (average: $10.43/hour), and activities
performed by the PH (e.g., home and hospital visits) varied among projects. In BPHP projects
breastfeeding initiation increased 18.3% from 2003 and 2007, compared to 12.8% (p

813-844-7613; ihernand@health.usf.edu
ABSTRACT
Background: The Hispanic community in the United States is diverse and heterogeneous with
cultural variations within and among the Hispanic ethnic groups. Breastfeeding behaviors are
different among Hispanic subgroups and may reflect the value or worth given to breastfeeding in
their country of origin. In addition the different sources of change and stress that occur with the
process of acculturation can affect the decision and duration of breastfeeding practices in the
U.S.
Goals: 1. To examine acculturation research on breastfeeding practices of Hispanic women in the
U.S. 2. To determine the existence of knowledge gaps for the direction of future research. 3. To
provide recommendations when providing breastfeeding assistance to Hispanic women in the
U.S.
Method: The method used was a systematic review of the literature utilizing CINAHL, Pubmed
along with hand search of original articles and reviews. Key search terms acculturation, Hispanic,
Latina, and breastfeeding.
Results: Overall, research on acculturation into American culture and breastfeeding practices has
focused on Mexican and Mexican- American mothers, used proxy measures of acculturation and
has found those with low levels of acculturation to American culture to be more likely to initiate
breastfeeding successfully.
Conclusions: Current recommendations for research studies of acculturation and breastfeeding
practices are to include women of ethnicities other than Mexican, to collect country of origin
information, use valid and reliable measures of acculturation and to collect information on
behaviors know to affect breastfeeding. These findings can then be used to assist in the
development of culturally appropriate interventions.
THE INFANT AS A DIAGNOSTIC TOOL IN THE COMMUNITY: NORMAL DEVIATIONS IN
FULL TERM WELL INFANTS
Ailsa Rothenbury, MA, RN, RM, IBCLC
Child and Adolescent Community Health, DOH Western Australia
1 Ellerby Way
Koondoola, Western Australia 6064
08 9342 6301; arothenbury@iinet.net.au
ABSTRACT
Background: A decade of clinical practice in a community child health clinic in Perth, led to the
development of low tech, low cost strategies for the correction of infant feeding difficulty in the
first eight (8)weeks of life.
Goals: To correct feeding deviations in infants whose mothers plan to breastfeed to 6 months of
age. All infants ‘should’ have achieved a coordinated suck-swallow-breathe cycle by 4 weeks.
Bottle feeders are also assessed and corrected.
Methods: The Intergalactica assessment format is used to individualize treatment strategies
Results: Over the past decade the focus shifted from maternal factors to infant factors (as
primary cause of premature weaning). Common issues are:
• undiagnosed ankyloglossia ,

• pain/discomfort from postural turn and/or tight temporomandibular joint,
• pain/discomfort from gastric acid reflux.
Most infants (about 75%) improve within 2-3 days, requiring only one visit, the remaining 25%
require a second or third visit. Issues which are unresolved within 4 visits (about 2 weeks) are
referred to a physiotherapist or other appropriate health professional.
Conclusion: Once feeding is pain free, duration of breastfeeding normalizes. Premature weaning
does not occur as often and maternal goals for breastfeeding duration are achieved.
A COLLABORATIVE RELATIONSHIP TO FACILITATE CLINICAL RESEARCH
Jane Grassley, PhD, RN, IBCLC; Deborah Bryson, RN, BSN, IBCLC
Texas Woman's University
1521 Fuqua Dr.
Flower Mound, TX 75028
940-898-2420; jgrassley@twu.edu
ABSTRACT
The importance of evidence-based practice as the basis for clinical decisions in the care of
breastfeeding families has encouraged lactation consultants and nurses to consider conducting
their own research projects. However, they may find the thought of designing and conducting a
study a daunting process best left to those who work in academic settings. Faculty on the other
hand have the knowledge and skills for conducting research projects, but may face barriers to
finding suitable settings for conducting their research. Research collaborations between those
who work in clinical settings and faculty can be formed to facilitate clinical research. The purpose
of this project poster is to describe one such collaboration between a hospital and a college of
nursing. One goal of this reciprocal relationship is to provide a safe and supportive environment
for clinicians to submit their work for thoughtful review and encouragement of their research
projects. Serving as consultants, faculty members mentor the masters’ prepared nurses who in
turn mentor nurses in their departments in developing ideas for research studies. Examples of
collaboration include a current research project with the hospital’s lactation consultants related
to breastfeeding support for adolescents and a workshop where nurses were given the
opportunity to describe their research ideas and receive feedback from a small group discussion.
Suggestions for developing collaborative research relationships will be presented.
RESEARCH POSTERS
EVALUATING A BREASTFEEDING SUPPORT INTERVENTION
Becky Spencer, RN, MSN, IBCLC, LCCE;
Jane Grassley, PhD, RN, IBCLC; Becky Law; Susie Gregory
4641 Biltmoore Dr.
Frisco, TX 75034
972-400-8985; bspencer@twu.edu
ABSTRACT
Background: Research has identified that grandmothers’ knowledge, attitudes, and experiences
influence their daughters’ decisions about breastfeeding. Grandmothers can offer more effective
support when interventions address their breastfeeding concerns.
Purpose: To evaluate an intervention to facilitate grandmothers’ knowledge and support of
breastfeeding.

Methods: A pilot study with a quasi-experimental two group post-test design was used to test
one hypothesis: grandmothers who participate in the intervention will demonstrate greater
scores for attitudes, knowledge, and intent to recommend breastfeeding than those in the
control group. The experimental group attended an interactive educational event, a
grandmother’s tea; the control group received materials written for grandmothers. Instruments
used: Iowa Infant Feeding Attitude Scale, a 20-item objective knowledge test, and a visual
analog scale.
Results: The convenience sample was comprised of 49 grandmothers (experimental n=26;
control n=23). An independent t-test found that the intervention group (M = 18.58, SD = 1.27)
had greater post-test knowledge scores than the control group (M =17.61; SD = 1.62; p =
.023), but had no significant differences in intent. A multivariate analysis of variance was run on
the conceptual factors of the Iowa scale. Examination of univariate effects showed that the
experimental group (M = 4.36) had higher scores on attitudes related to valuing breastfeeding
than did the control group (M = 3.97) (F = 5.19; p = .027).
Discussion: Participation in the grandmothers’ tea appears to affect knowledge and some
attitudes. More investigation of grandmothers’ attitudes and their impact on breastfeeding
support are needed.
LOOKING AT THE FUTURE NOW: EXPLORING THE PERCEPTION OF UNMARRIED IN-
SCHOOL NIGERIAN ADOLESCENTS TOWARDS BREASTFEEDING
Olukemi Sabageh, MBBS, MD, MPH; Yinyinade Ijadunola, MB, ChB, MD, MPH; Olorunfemi
Ogundele, MB, ChB, MD; Akinlolu Omisore, MB, ChB, MD
Obafemi Awolowo University Teaching Hospital
Ile-Ife, Osun state 220005 Nigeria
+234-803-315-9030; ksabageh@yahoo.com
ABSTRACT
Background: The superiority of breast milk compared to other milk for the nourishment of
infants offering better benefits has been established by various researchers. In Nigeria however,
young infants may not benefit from such practices as a result of poor knowledge and attitude
towards breast feeding practice. The knowledge of breastfeeding should start early as possible
because this will influence future choices. Adolescents are seen as “gatekeepers to health”, their
behavior and sexuality are important contemporary issues because behavioral patterns acquired
during this period tend to last throughout adult life.
Goals: This study therefore aimed at assessing the knowledge and attitude of unmarried inschool
adolescents towards breastfeeding and identifying factors influencing their future choices.
Methods: The design was cross-sectional in nature. Four hundred secondary school respondents,
aged 10-19 years, were selected using a multistage sampling technique and self administered
questionnaires were administered.
Results: 400 respondents were interviewed 51.5% (206) of which were male and 48.5 %( 194)
were females with a mean age of 14.82 years. Even though the knowledge about breastfeeding
and its health benefits were adequate among respondents with 89.2% knowing that breast milk
is protective, their attitude were poor as 57.5 % felt mothers should not breast feed even with
modest anywhere.
Conclusion: The important predictors of breastfeeding are knowledge and social influences. This
has great implications for health promotion on breastfeeding among the young people.

OUTCOMES OF TEACHING BACCALAUREATE NURSING STUDENTS ABOUT MASTITIS
UTILIZING A MULTIMODAL TEACHING TOOL
Denise Smart, BSN, MPH, DrPH
4710 west Tiffany Ave
Spokane, WA 99208
509-324-7255; dsmart@wsu.edu
ABSTRACT
Experiencing mastitis during breastfeeding can be a painful and frightening experience for a
mother. Complications of septicemia, abscesses or the complete removal of a breast have been
known to interrupt infant breastfeeding. Several factors influence the variations in reports of 10-
33% incidence of mastitis with underreported cases perhaps the most significant effect.
Underreporting has devalued the actual incidence among women, limiting the priority of its
inclusion in postpartum teaching by nurses. The majority of literature reviewed for this study
and used in educating students and practicing nurses lacks current evidence based anatomy and
physiology of the breast during lactogenisis as well as the pathophysiology of mastitis. This, in
combination with traditional teaching methods, ill-equips the nurse to educate the new mother.
Current cognition studies support the use of multimodal teaching tools to maximize student
learning. This study compared the knowledge acquired and retained regarding postpartum
mastitis utilizing single traditional teaching methods and a 22 minute multimodal learning video
on mastitis to baccalaureate nursing students. Results of this study highlight a significant
difference in knowledge acquisition after viewing the designed multimodal teaching tool.
Student’s self-reported confidence and comfort level in explaining and caring for a woman with
mastitis increased. Baccalaureate student nurses were able to better articulate a description and
treatment of mastitis to a new mother as well as to other health care professionals. These
results may influence the future developments of multimodal tools in universities, increasing the
cognition of nurses in educating and preparing patients about postpartum complications.
THE RELATIONSHIP BETWEEN INTRAPARTUM INTRAVENOUS THERAPY AND NEWBORN
WEIGHT LOSS: CHALLENGING THE 7% RULE OF THUMB FOR EARLY
SUPPLEMENTATION OF THE BREASTFED INFANT
Kim Ann Sheehan, RN, BScN, MSc; Brent E Faught; Michael J Plyley, BSc (Hon) PhD
49 Ranchdale Drive
Hamilton, ON L8V2L9 Canada
905-741-4587; ksheehan@mountaincable.net
ABSTRACT
Objectives: The purpose of this retrospective, cross-sectional design was to examine the
relationship between intrapartum intravenous therapy and weight loss in newborns.
Methods: A database was established from the chart data of 100 mother-baby dyads. Statistical
analyses included univariate, multivariate, stepwise multiple linear regression, and receiveroperator
characteristic curve analysis.
Results: Results indicated that the volume of intravenous therapy and method of delivery are
significant predictors of weight loss in the newborn (R2=15.5, p

infants received an average of 673ml more intravenous fluid than infants who lost ≤7% of birth
weight, suggesting a fluid shift exists.
Conclusions: These results have significant implications for clinical practice as previous studies
have shown that early supplementation interferes with the establishment and exclusivity of
breastfeeding, leading to decreased maternal confidence, and shorter breast feeding durations.
To prevent postpartum weight losses in excess of 7%, clinicians should plan carefully the use of
intravenous therapy. If practitioners are unable to limit the amount of intravenous therapy to a
level below the cut-point (1225ml), clinicians should expect that the infant’s weight loss will
exceed 7%, which should be taken into account before considering supplementation of breastfed
infants in the absence of any clinical symptoms of dehydration.
THE EFFECT OF STRUCTURED GROUP PRENATAL EDUCATION ON BREASTFEEDING
CONFIDENCE, DURATION, AND EXCLUSIVITY TO TWELVE WEEKS POSTPARTUM
Patricia Lynn Olenick, RNC, CNM, PhD
Texas A&M University- Corpus Christi
1141 Oak Ave
Rockport, TX 78382
361-825-2270; ivan-patricia@sbcglobal.net
ABSTRACT
Background: Breastfeeding exclusivity & duration remain below U.S. 2010 goals. Self-efficacy
literature supports the premise that increased maternal confidence prevents premature weaning.
Goals: 1. To determine if group prenatal education can improve breastfeeding outcomes in a
private practice population. 2. Identify the relationship between maternal confidence (measured
with the Breastfeeding Self-Efficacy Scale) and breastfeeding outcomes.
Methods: A randomized, controlled prospective trial on whether one class based on breastfeeding
self-efficacy theory improves outcomes.
Results: 182 mothers participated in the study with 168 completing data collection; the majority
were Hispanic, married, and low-income. Breastfeeding confidence was associated with higher
rates of full breastfeeding at weeks one, six and twelve. High versus low confidence was
associated with longer duration (10 weeks vs. 5). The group class (intervention) was not
associated with significant differences in outcomes with “intent to treat” analysis. However, in
analysis by actual attendance, there were consistent differences in at-risk subgroups. For
example, at 12 weeks, the “any breastfeeding class” group had higher “full breastfeeding” rates
for Cesarean mothers (35% vs. 8%). Mothers without prior breastfeeding experience (35%
vs.11%). Both sub-groups also had longer duration (9 vs. 6 and 5 weeks, respectively) with
breastfeeding class attendance. In multivariate analysis, the effects of actual attendance to any
breastfeeding class on rates of full breastfeeding were confirmed at one week postpartum.
Breastfeeding confidence was consistently a strong predictor of exclusivity and duration.
Conclusions: Breastfeeding education shows potential for improving breastfeeding outcomes,
especially in at-risk subgroups. Increased maternal confidence improves exclusivity & duration.
CURRENT BREASTFEEDING KNOWLEDGE OF SENIOR UNIVERSITY NURSING STUDENTS
Azza H Ahmed, DNS, RN, IBCLC, CPNP;
Diana C L Bantz, PhD, BC-FNP; Clara J Richardson, MSN, RN-BC
Purdue University

3221 Conington Street
West Lafayette, IN 47906
765-494-4040; ahmedah@purdue.edu
ABSTRACT
Background: Studies in the past have found that nurses have inadequate knowledge about
breastfeeding topics and suggested improvement in breastfeeding education.
Objective: To assess the current breastfeeding knowledge of senior nursing students and to
examine the variables associated with breastfeeding knowledge and skills.
Method Design: An exploratory descriptive design. Subjects: A total of 115 senior nursing
students from two different Midwestern universities filled out the questionnaire. Inclusion criteria
included students who finished maternal/child nursing didactic and clinical courses, and were
regular bachelor senior nursing students and second degree students. Instrument: A
Breastfeeding Knowledge Questionnaire was adapted from Brodribb, Fallon, Jackson, and
Hegney (2008). The questionnaire consisted of 24 items covering three main categories in
including benefits of breastfeeding, physiology of lactation and feeding adequacy, breastfeeding
skills including exclusive breastfeeding, maternal conditions that may affect breastfeeding, and
common breastfeeding problems. Statistical Analysis: Two-tailed t test and Pearson correlation
were used to test the differences in breastfeeding knowledge and the relationship between the
knowledge categories.
Results: Findings revealed a significant difference in the students’ knowledge regarding
physiology and benefits (t = -3.615, p = .000) and benefits and skills (t = 5.255 and P = .000).
There was also significant correlation between knowledge of physiology and benefits (r = 0. 241,
p = .009) and benefits and skills (r = .027, p = .000).
Conclusion: More strategies to improve breastfeeding education in nursing curriculum focusing
on breastfeeding skills need to be addressed.
THE BUTTERBALL TURKEY EFFECT: MATERNAL IV FLUIDS AND INFANT WEIGHT
Robin Lynn Hirth, Med, BS, IBCLC; Tina Leigh Weitkamp, MSN, BSN
Mercy Hospital Fairfield
6085 Springdale Road
Cincinnati, OH 45247
513-870-7883; rlhirth@health-partners.org
ABSTRACT
Background: Health care providers use infant weight loss in the first few days of life as a
measurement of effective feeding. Breastfeeding supplementation or increased formula feeds are
often recommended with an infant weight loss of 7-10% of birth weight.
Goal: This study goal was to examine if the amount of maternal IV fluids during labor affects
average birth weight and subsequent weight loss of infants.
Methods: The study was a retrospective review of medical records for mother/infant dyads.
Study population was a random sample of 200 mothers/infant dyads delivering at one
Midwestern hospital. Exclusion criteria for dyads included: conditions impacting health and
weight of the infant, infants with birth weight 4000 gm, and/or infant gestational age
42 weeks. A data collection tool was utilized to review medical records and record data.

Results: The results indicate no relationship between total maternal IV fluid intake and birth
weight. However, a significant relationship was observed between IV fluid intake per minute of
labor (flow rate) and weight loss on day of life two. For example, at the slower flow rates (0-5),
a statistically significant negative linear exists with percent weight loss on day of life two (p=
.003). From the flow rate of 5 and above, there is no relationship between flow rate and weight
loss.
Conclusions: IV intake does impact weight loss, with low flow. Further analysis is underway to
elucidate these and other relationships.
BREASTFEEDING AMONG RURAL PANAMANIAN WOMEN: INITIATION AND DURATION
FACTORS
Alexandra Hayes, MA
Washington State University
1590 NE Northwood Drive, #E303
Pullman, WA 99163
954)-937-0755; afhayes@wsu.edu
ABSTRACT
Background: Although breastfeeding is an integral part of Panamanian culture, only 25% of
babies at six months of age are exclusively breastfed while only 38% receive any breastmilk at
nine months of age according to a 2007 UNICEF report. The high incidence of infant morbidity,
in terms of diarrheal episodes, is directly related to low breastfeeding rates.
Goals: To identify factors that affect breastfeeding initiation and duration to recommend
culturally appropriate public health campaigns.
Methods: Semi-structured interviews were conducted with rural Panamanian women aged 18-35
with at least one child under the age of five.
Results: The results indicate that women with the following had higher initiation and duration
rates: support networks that involved at least a mother and a male spouse or boyfriend,
prenatal education class participation, and delivery in hospitals that did not supply formula to
infants and also encouraged breastfeeding and rooming-in.
Conclusions: The data imply that these factors should be considered in Panamanian public health
and breastfeeding campaigns in ways such as designing prenatal education classes that discuss
alternative feeding methods and the situations that precipitate their uses, and audio-visual
message development that promotes breastfeeding as a family decision with emphasis on
paternal involvement and influence.
ATTRIBUTIONS OF BREASTFEEDING DETERMINANTS IN A FRENCH POPULATION
Paloma Trejo Hernandez, BA, MA; Stacey Callahan, PhD
37 rue Pierre d''Aragon
Toulouse, Haute Garonne 31200 France
0033665582787; trejo@univ-tlse2.fr
ABSTRACT
Background: Breastfeeding initiation and duration rates in France are low when compared to
other European countries.

Goals: Our objective was to determine attributions of breastfeeding determinants in a French
population.
Methods: A self-report survey listing 68 reasons for/against breastfeeding was developed. 909
participants from the general population rated their level of agreement with each reason through
a Likert-type scale. The survey explored gender, age, parenthood, decision to breastfeed, having
friends and family members who had breastfed, and having been breastfed themselves when
younger. Exploratory factorial analyses extracted six factors for and five factors against
breastfeeding. All factors were entered in regression analyses to predict demographic variables
that determined attributions for/against breastfeeding. Individuals were measured at two points
in time to account for test-retest reliability (28.1 days ± 6.95 day lapse).
Results: Determinants varied significantly with respect to gender, age, parenthood, and
breastfeeding history. High endorsement for breastfeeding involved breastfeeding to fulfill
gender roles, to prevent health risks, and because of external encouragement; little
endorsement was given for the physiological advantages for babies, pleasant sensations, and
preference factors. In terms of not breastfeeding, high endorsement was observed in lack of
support, negative attitudes, and infant formula reasoning factors; medical and physiological
reasons for not breastfeeding showed low endorsement.
Conclusions: Results showed a strong impact of society and cultural norms. To increase initiation
and duration rates, we suggest approaching the rest of the population in addition to pregnant
women and mothers since society as a whole influences the decision to breastfeed.
COMPARISON OF UGANDIAN MOTHER'S MILK EXPRESSION TECHNIQUE FOR INFANTS
IN SPECIAL CARE NURSERIES
Beverly Curtis, MSN, RN, PNP-BC, IBCLC; Tina M Slusher, MD; Ida Slusher, RN, DSN; Eleanor
Smith, MD; Margaret Nakakeeto, MBChB, Mmed
96 Acheson Avenue
Washington, PA 15301
412-466-5004; beverlyanncurtis@yahoo.com
ABSTRACT
Background: Health experts agree that breastmilk is the superior infant milk. Preterm infants
most at risk for morbidity and mortality in developing countries are identified as needing
exclusive feedings of their own mothers milk for optimal health and survival. Yet collecting
mother s milk in suitable volumes to support preterm growth is a challenge even in developed
nations with state of the art nurseries. Mothers in developing countries face more challenges in
providing milk for their infants. With lack of transportation, poor resources for food and limited
availability of electricity, mother s have difficulty providing enough milk to support the
nutritional needs of their infants. Therefore, with inadequate milk volumes, artificial feedings
become necessary, potentially compromising infant health.
Objective: The objective of this study was to compare breastmilk volume using three breastmilk
expression techniques. One hundred fifty eight Ugandan mothers whose infants were too ill or
premature to directly feed from the breast used one of three methods for breast milk
expression: double electric breastpump, non-electric manual breastpump, or hand expression.
Design/Methods: This study used a quasi-experimental design. Mothers were assigned at
delivery to one of three breast milk expression groups, using non-probability sampling. Maternal
milk volume (MMV), the dependent variable, was measured for seven days. Data were analyzed

using a one-way ANOVA and the Tukey HSD test.
Results: MMV per total time was evaluated among the three groups using a one-way ANOVA (p<
0.002). The Tukey revealed significant differences in MMV (p< 0.01) between mothers using the
electric breast pump and those using hand expression. MMV for the hand pump (non-electric
manual breastpump)was not significantly different from either the electric breast pump group or
the hand expression group.
Conclusions: The findings reveal a greater MMV with use of an electric breastpump and earlier
adequate MMV for support of infant growth than with hand expression.This data has important
implications for providing exclusive own mothers milk feedings for vulnerable ill or premature
infants in developing countries.
THE EFFECT OF FENUGREEK ON MILK PRODUCTION AND PROLACTIN LEVELS IN
MOTHERS OF PREMATURE INFANTS
Carol Reeder, BSN, RN, IBCLC;
Anita Legrand, BSN, RN; Susan O'Conner-Von, PhD, RN
St. Luke's Hospital
1026 A. Avenue N.E.
Cedar Rapids, Iowa 52402
319-369-8944; reedercj@crstlukes.com
ABSTRACT
Background: Breast milk is the optimal form of nutrition for preterm infants (American Academy
of Pediatrics). Not all mothers provide breast milk for their preterm infants. A significant number
of women use alternative therapies, yet a paucity of evidence exists addressing the use of
biologically based practices to enhance lactation. The herb fenugreek (Trigonella foenumgraecum)
has been purported to be an effective
galactogogue, with reports of women worldwide consuming fenugreek to facilitate lactation
during the postpartum period.
Goal: The goal of this pilot study was to determine if fenugreek increased breast milk volume
and prolactin levels (PRL) in mothers of preterm infants.
Methods: Using an experimental design, the convenience sample included 26 mothers of infants
less than 31 weeks gestation at a Midwest urban medical center. After a baseline PRL level, each
mother consumed three capsules of fenugreek (or placebo), three times per day for 21 days.
Mothers initiated pumping within 12 hours of delivery and kept a daily record of pumping
frequency and breast milk volumes. In addition, PRL levels were drawn every week during the
21 day study period.
Results: Data analysis revealed no statistical difference between the mothers receiving
fenugreek or those receiving placebo in terms of milk volume or PRL. Of clinical importance, no
adverse effects were noted in the mothers or preterm infants.
Conclusion: This pilot study provides a foundation for lactation consultants to conduct future
research examining the efficacy and safety of fenugreek as a galactogogue for mothers of
preterm infants.
INFLUENCE OF THE MEDIA ON INFANT FEEDING PATTERNS IN THE HOSPITAL
Anne Merewood, MA, MPH, IBCLC; Jana Chaudhuri, PhD; Xena Grossman, RD, MS

Boston University School of Medicine
88 E Newton St, Vose 3
Boston, MA 02118
617-414-6466; anne.merewood@bmc.org
ABSTRACT
Background: Infant feeding information is widespread in the media, through advertising, news,
opinion pieces and instructional articles. The Infant Feeding Practices Study II (IFPS II), was a
US-based longitudinal, mail-in survey conducted by the FDA from 2005-2007, to document
infant practices through year 1 of life.
Objectives: Determine: (1) Exposure among pregnant women to infant feeding information in
the media; and (2) Impact of exposure on breastfeeding behavior in the hospital.
Methods: Exposure and infant feeding status were assessed through questionnaires asked
prenatally and at one month postpartum.
Results: 84% (3959/4688) of pregnant women reported exposure to breastfeeding information
in the media; 90% (4219/4688) reported exposure to formula information and 8% (373/4688)
reported no exposure. More women saw formula information than breastfeeding information in
all media; in TV, 71% of women were exposed to formula but only 34% to breastfeeding
information. In-hospital breastfeeding initiation was 85%; exclusivity was 43%. After
multivariate logistic regression, exposure to breastfeeding information was associated with
increased initiation (AOR 2.64; 95% CI 1.78-3.91) and exclusivity (AOR 1.4; 95% CI 1.03-
1.89); exposure to formula feeding information was associated with lower initiation (AOR 0.43;
95% CI 0.24-0.76); and exclusivity (AOR 0.66; 95% CI 0.45-0.96). The association existed
despite a considerable overlap in exposure.
Conclusion: Prenatal exposure to infant feeding information in the media is strongly associated
with breastfeeding patterns in the hospital.
BANNING THE BAGS: ENCOURAGING TRENDS IN HOSPITAL-BASED FORMULA SAMPLE
PACK DISTRIBUTION
Radha Sadacharan, BA; Xena Grossman, RD, MS; Marsha Walker, RN, IBCLC; Alison Stuebe,
MD, MSc; Melissa Bartick, MD; Amelia Psmythe; Anne Merewood, MA, MPH, IBCLC
The Breastfeeding Center, Boston Medical Center
88 E Newton St, Vose 3
Boston, MA 02118
617-414-6466; radha.sadacharan@bmc.org
ABSTRACT
Background: In 2007, researchers completed a national survey to assess distribution of formula
sample packs in US hospitals. Ban the Bags is a national movement aimed at eliminating sample
pack distribution. In 2009 researchers performed a new study to assess possible changes in
practice.
Objective: To determine whether changes have occurred in sample pack distribution practice
since 2007.
Methods: In 2007, we called all US hospitals to obtain data. In 2009 we relied on self-report:
when a hospital recorded removal of sample packs to Ban the Bags, a research assistant called
the hospital’s maternity service for verification, then added the hospital to the list of “bag free”
sites.

Results: Between 2007-2009, the number of bag free US hospitals increased from 282 to 367,
(9% to 12%). Texas saw the largest increase, from 3 (1%) to 16 (6%). Oregon had the greatest
proportional increase, from 33% to 59%. In 10 states, >25% of hospitals are now bag free; in 3
states, >50% of hospitals are bag free. Seven states have no bag free hospitals. The 10 states
with the greatest number of bag free sites in 2007 saw a 10% increase in sites by 2009, but the
10 states with the fewest sites in 2007 had 85 years, or had missing lactation history or
number of births, cardiovascular disease, or used antihypertensive medication, leaving 18 543
women for analysis. Multivariate statistical analyses were performed in general linear models
and by logistic regression according to categories of lifetime duration of lactation. The results
were adjusted for age, smoking, education and physical activity.
Results: Lactation was inversely associated with systolic and diastolic blood pressure (p for trend
< 0.001). Women who had never lactated had 4.2 mmHg (95% CI, 2.7 to 5.7) higher systolic
blood pressure and 2.9 mmHg (95% CI, 2.0 to 3.8) higher diastolic blood pressure than the
reference group of women who had breastfed ≥24 months. A similar comparison showed that
the prevalence of hypertension was higher among those who had never lactated (OR 1.55; 95%
CI, 1.28 to 1.88).
Conclusion: Decreased lifetime duration of lactation was inversely associated with systolic and
diastolic blood pressure, and with a higher prevalence of hypertension. Breastfeeding may thus
influence women’s future cardiovascular disease risk.
BREASTFEEDING EDUCATION AND SUPPORT TRIAL FOR OBESE WOMEN: EFFECTS OF A
SPECIALIZED PEER COUNSELING INTERVENTION ON BREASTFEEDING AND HEALTH
OUTCOMES

Donna J Chapman, PhD, RD; Katherine Morel, MS; Angela Bermudez - Millan, PhD; Sara Young,
RN, MSN, IBCLC; Grace Damio, MS, CD/N; Nan Kyer, IBCLC; Rafael Pérez - Escamilla, PhD
University of Connecticut, Dept. Nutritional Sciences
Storrs, CT 06269
860-486-0630; donna.chapman@uconn.edu
ABSTRACT
This randomized trial evaluated the efficacy of a specialized peer counseling (PC) intervention
promoting exclusive breastfeeding to overweight/obese low-income women. During pregnancy,
206 overweight/obese women considering breastfeeding were recruited and randomized to
receive a specialized PC intervention (3 prenatal home visits, daily in-hospital breastfeeding
assistance and up to 11 postpartum home visits) or standard care. At this Baby Friendly
hospital, standard care included routine in-hospital breastfeeding support with the option of
receiving standard PC services at a similar intensity. Demographic, biomedical and infant feeding
data were collected at birth, 2 weeks, and monthly through 6 months postpartum. Medical
records were reviewed. Bivariate and logistic regression analyses identified predictors of
breastfeeding and infant health outcomes. Healthy, term infants were delivered by 154 women
(76 intervention, 78 control) who continued to meet inclusion criteria. Breastfeeding initiation
was nearly universal with 97.4% and 98.7% initiating breastfeeding in the intervention and
control groups, respectively. At 2 weeks and 2 months postpartum, women in the intervention
group tended to be more likely to breastfeed than controls (93.1 vs. 83.8% (p=0.08) and 67.7
vs 54.0% (p=0.11), respectively). Logistic regression analyses adjusted for baseline group
differences in age and delivery mode indicated that control group infants were 3.5 times more
likely to be readmitted to the hospital by 3 months of age than intervention group infants (OR =
3.463, 95% CI: 1.009 – 11.888). These preliminary findings suggest that specialized
breastfeeding peer counseling reduced the re-hospitalization rate of infants born to low-income,
overweight/obese women.
PEER COUNSELORS IMPROVE BREASTFEEDING TECHNIQUE AMONG OBESE WOMEN
Katherine Morel, MS; Donna J Chapman, PhD, RD; Nan Kyer, IBCLC; Angela Bermudez - Millan,
Ph.D.; Sara Young, RN, MSN, IBCLC; Rafael Pérez - Escamilla, Ph.D.University of Connecticut
3624 Horsebarn Hill Ext., Unit 4017
Storrs, CT 06269
860-462-2929; Katie.Wetzel@gmail.com
ABSTRACT
Data included in these analyses are derived from a larger randomized control trial (N=206)
evaluating a specialized peer counseling intervention targeting obese, low-income women (3
prenatal, daily in-hospital and up to 11 postpartum visits). The control group received standard
care which included access to a standard peer counselor. These analyses include a subset of 45
women from the larger study(Intervention n=22, Control n=23). The objective was to evaluate
the impact of a specialized breastfeeding peer counseling intervention on breastfeeding
technique. Two breastfeeding sessions were videotaped on days 2, 4, and 7 postpartum.
Videotapes were edited to remove identifying characteristics. These sessions were later viewed
and rated independently by 3 Internationally Board Certified Lactation Consultants utilizing the
Infant Breastfeeding Assessment Tool (IBFAT) and Via Christi Breastfeeding Assessment Tool
(VC). Between group differences were compared using T-tests. There was no significant
difference in IBFAT or VC scores on days 2 and 4 postpartum. On day 7 postpartum better
breastfeeding technique was observed in the intervention group with significantly higher VC
scores vs. controls (7.5±1.0 vs. 5.6±3.3, respectively p=0.026). IBFAT scores tended to be
higher in the intervention vs. controls (11.5±1.2 vs. 9.4±4.3, p=0.068, respectively). Maternal
report of contact with a peer counselor during the first week postpartum was significantly higher

in the intervention group vs. controls (143.8±101.6 vs. 39.8±37.1, p=0.001, respectively).
These preliminary findings suggest that specialized breastfeeding peer counselor provided at a
high intensity level during the first week postpartum improved breastfeeding technique by day 7
postpartum.
EVALUATION OF A BREASTFEEDING ASSESSMENT SCORE IN A DIVERSE POPULATION
Anne Mercer, RN, MSN, IBCLC; Susan L Teasley; Robert T Hall; Judy Hopkinson;
Deanna McPherson; Stephen D. Simon
Children's Mercy Hospital & Clinics
2401 Gillham Rd
Kansas City, Mo 64108
816-234-1612; amercer@cmh.edu
ABSTRACT
Background: Our previous study performed in suburban populations developed a breastfeeding
assessment score (BAS) that was designed to predict, prior to initial hospital discharge, those
mothers who would discontinue breastfeeding within the first ten days of age.
Goal: To assess the BAS in a more diverse population.
Methods: Patients were recruited from three urban hospitals serving patients primarily supported
by public funding.
Results: The current study with 1182 mother-infant pairs confirmed that the five variables
scored on a 0-2 scale (maternal age, previous breastfeeding experience, latching difficulty,
breastfeeding interval, number of bottles) remained highly significant, p=0.000, for predicting
discontinuation of breastfeeding in spite of significant inter-hospital differences in the variable
outcomes. The mean BAS was lower (5.6 vs 7.8) and the cessation rates were higher (15% vs
11%) in the current study than the original study. The BAS was demonstrated in both
populations to identify those at risk of early breastfeeding cessation in an inverse relationship to
the score.
Conclusions: Data from the current study in a racially and socioeconomically diverse population
validate those findings in the original study which evalusted a primarily suburban, white, middle
class population. These observations confirm the use of the five variables to predict early
breastfeeding cessation. Those at an early risk of cessation of breastfeeding , identified by the
BAS, may benefit from early identification and a lactation consultation. Special consideration
should be given to patients with a BAS

The design was qualitative , involving 22 women. Audio-taped diaries kept for ten days and
video recordings (4) elicited the women's experience of SSC. Difficulties encountered during
recruitment indicated the need for education of the interpreters involved in the research process
on promoting expressed wishes of patients.
Participants used powerfully emotive language to describe their experiences of SSC. Findings
revolved around "Getting to Know Each Other", "Instinctive Breastfeeding"; "Touching,
Smelling"; "Gaze"; "Bodily Fluids in the Cultural Context of Birth". The findings indicated the
need to educate midwives about the effects of SSC on mother, baby and family relationships and
to point out their role in protecting the birth environment at this sensitive time.
Participants said it felt "instinctive" to bring their babies to their breasts and feed during this
intimate time, SSC may increase breastfeeding rates and meet government targets. The baby
was seen as a "reward" for the rigour of birth; bodily fluids at birth were viewed as "natural and
normal" ; yet in the cultural context they were seen as contaminating and polluting. This
highlights the vital need for women's voices to be heard and to be central to policies and
practices as recommended by the DOH(2005.2006)