Managing breastfeeding expectations and outcomes among expectant mothers
Women who intend to breastfeed their babies but are subsequently unable to do so have higher rates of postpartum depression (PPD), according to a recent UK study in the Maternal and Child Health Journal. The researchers from Spain and the UK aimed to determine whether breastfeeding, its duration and exclusivity affects the mental health of mothers and their risk of PPD.
A sample of more than 14 000 mothers of infants born in the Bristol area in the 1990s was selected from data extracted from the Avon Longitudinal Study of Parents and Children. The mean age of mothers was 28.3 years and the majority were white (95%) and married (86%). The researchers used the Edinburgh Postnatal Depression Scale to screen for both antenatal depression and PPD, collecting data at 18 and 32 weeks gestation, and 8 weeks, 8, 21 and 33 months postnatally.
The the risk of PPD was higher among women whose intentions regarding breastfeeding did not match reality. This was the case both in relation to mothers who wished to breastfeed but were unable to do so, as well as mothers who did not wish to breastfeed but ended up having to.
This study emphasises the importance of gaining insight into expectant mothers’ history of depression and their intentions to breastfeed. This knowledge can help midwives manage women's expectations, explore the possibility of alternative outcomes and provide appropriate information and psychological support so that women can feel comfortable and confident when faced with different breastfeeding realities than the ones they have planned for.
Prenatal meditation and infant health outcomes
A recent study from Hong Kong published in Infant Behavior and Development sought to explore the relationship between prenatal meditation and infant temperament, behaviour and overall health. The author developed an Eastern-based meditative intervention (EBMI) and recruited pregnant Chinese women between 12 and 28 weeks gestation in Hong Kong. The intervention group (n=63) received 6 full sessions of EBMI while the control group (n=59) received only an introductory lecture without any of the EBMI element practices.
In addition to breathing practices, the EBMI in this study includes mindful walking, helping oneself and others, and crisis intervention consisting of turning perceived curses into blessings. ‘This intervention is focused on the practice of meditation in daily life’, says Ka-Po Chan, the author of the study.‘The idea is not to put extra burden on the pregnant woman when she does something extra,’ says Chan, who believes midwives are best placed to guide pregnant women to carry out their daily activities, such as eating and pre- or postnatal exercise, in a mindful way.
Cord blood cortisol levels were chosen as an indicator for fetal health and salivary cortisol levels as an indicator of mental health. Mothers were also asked to fill out the Carey Infant Temperament Questionnaire at around the fifth month after delivery to determine the impact of meditation on babies’ emotional temperament. Data showed that blood cortisol levels were higher among infants whose mothers were in the EBMI group and those who frequently practiced EBMI (more than three times a week). These infants also had a more positive response to new stimuli, an overall better temperament, and lower use of special neonatal care. However, Chan acknowledges that results should be received with caution owing to the small sample size and instances of missing data.
A policy push for breastfeeding and infant health
The relationship between breastfeeding and infant health has been well established in the UK and exclusive breastfeeding is recommended for the first 6 months of life (Department of Health, 2011). Although such recommendations are available in Vietnam, country-specific data to push for policy changes and Government initiatives are lacking.
Researchers investigated the impact of breastfeeding practices on diarrhoea and acute respiratory infection (ARI) prevalence among infants aged 0-5 months in Vietnam. The study, published in the International Breastfeeding Journal, collected data via face-to-face interviews, using a structured cross-sectional survey, with 6068 mothers across 11 provinces of Vietnam in 2011. Questions related to sociodemographic characteristics, infant feeding practices and prevalence of diarrhoea and ARI.
While half of all infants were breastfed within 1 hour of birth, only 20.2% of children were exclusively breastfed and 73.3% were given prelacteal foods in the first 3 days after birth. These prelacteal foods mainly included infant formula, water or honey.
This study found that infants who were predominantly breastfed (i.e. given water, water-based fluids and fruit juices in addition to breast milk) or partially breastfed (i.e. given other liquids and non-liquids in addition to breast milk) had higher instances of diarrhoea than those who were exclusively breastfed. Prelacteal feeding and partial breastfeeding were associated with higher levels of ARI than exclusive breastfeeding. The study concluded that Government interventions encouraging early and exclusive breastfeeding would improve child health in Vietnam.