BACKGROUND:Despite global and national efforts to promote exclusive breastfeeding, rates remain below international targets, partly due to the marketing of breastmilk substitutes (BMS). Nigeria adopted the International Code of Marketing of Breastmilk Substitutes and revised it as the National Regulations on the Marketing of Infant and Young Children's Foods and Other Designated Products. However, enforcement appears weak, and there is a dearth of information on health workers' knowledge and compliance with updated regulations. RESEARCH AIM:To assess the knowledge and level of compliance with the national regulations among the health workers. METHODS:This cross-sectional study (N = 100) was conducted with health workers in three selected states. A pretested self-administered questionnaire was used to elicit responses on knowledge and compliance with the national regulations. Interviews were conducted with senior-level officials, observational compliance checklist was used to assess compliance at the facility level. RESULTS:About a quarter (27%) of the health workers had adequate knowledge of the national regulations, 18% reported a high level of personal compliance, and 16% believed their health facility had a high level of compliance. Interviews with the participants further revealed limited awareness and lack of access to the regulations, indirect access to BMS, selective use of BMS, and a lack of protocols to address violations, all of which reinforce the overall low levels of knowledge and compliance with the regulations. CONCLUSIONS:Health workers' knowledge of and compliance with regulations and low. Attention should be given to ensuring proper dissemination, sensitization, training, and facility-level procedures to improve regulation adherence and protect breastfeeding.
Breastfeeding is a cost-effective intervention that improves survival and long-term health outcomes, yet policy mechanisms to support breastfeeding among medically ill infants and children are underdeveloped in many health systems. In Thailand, national breastfeeding promotion policies have historically focused on healthy term infants, resulting in fragmented and inequitable support for infants requiring hospital-based care. This study examines the development and national scale-up of a network-based breastfeeding promotion policy focused on breastfeeding support for sick infants and children, implemented across 13 health service regions. Guided by Stringer's action research framework, international evidence was systematically reviewed and adapted to the national context through interprofessional engagement, regional pilot implementation, and iterative policy learning. Spatz's Ten Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants were operationalized through coordinated hospital workflows, supported by regional knowledge exchange and field-based expert mentorship. Implementation across 74 pilot hospitals generated sustained improvements in policy-relevant indicators, including the rate of exclusive breastfeeding at discharge and the rate of exclusive breastfeeding at 6 months among medically ill infants. These outcomes directly informed the integration of breastfeeding indicators into national inspection and accountability mechanisms, representing a transition from project-based implementation to formal policy institutionalization. This policy experience demonstrates how regionalized health systems can translate evidence into scalable action for vulnerable populations. By aligning service delivery, governance structures, and performance monitoring, the Thai case offers transferable insights for strengthening national breastfeeding promotion policies in complex health systems and advancing equitable care for medically ill infants and children.
OBJECTIVES:Brazil has implemented important public policies to promote breastfeeding. However, differences in breastfeeding indicators across the country's regions persist. Therefore, this study aimed to assess regional differences in breastfeeding indicators in Brazil. PARTICIPANTS:Children under 5 years from the five Brazilian regions (North, Northeast, Southeast, South and Central-West). METHOD:This cross-sectional study used data from the Brazilian National Survey on Child Nutrition (ENANI-2019), conducted from February 2019 to March 2020. Breastfeeding indicators included: ever breastfed (EB), early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), and continued breastfeeding 12-23 months (CBF). Associations between region of residency and breastfeeding indicators were assessed using the Rao-Scott corrected chi-square test and adjusted Poisson regression. FINDINGS:In total, 14,558 children were studied. Crude analysis found associations between region of residence and three breastfeeding indicators. The associations remained after adjustment for potential confounders. EB was more prevalent in the North (PR = 1.04), Northeast (PR = 1.03), and Central-West (PR = 1.03) regions. The North region had a higher prevalence of EIBF (PR = 1.11), while Southeast (PR = 0.87) had lower prevalence. EBF showed a lower prevalence in the Central-West (PR = 0.89), whereas CBF (PR = 1.30) was more prevalent in the Northeast. The South region was the reference for all comparisons. CONCLUSIONS:The findings underscore the need for tailored regional public health strategies to achieve the World Health Organization-recommended breastfeeding practices in the Brazilian territory.
BACKGROUND:Most data investigating factors influencing exclusive breastfeeding in Australia is metropolitan based. AIM:This study aims to evaluate how maternal, birth, and neonatal characteristics relate to exclusive breastfeeding at discharge at a regional Australian hospital. METHODS:This was a retrospective observational study of perinatal data from 2018 to 2022. Exclusion criteria included maternal mastectomy, unknown breastfeeding status at discharge, maternal medications precluding breastfeeding and preterm birth. Univariate and multivariate analyses were completed against the outcome of breastfeeding status at discharge. Breastfeeding status was determined by recorded feeding status at discharge, which may not reflect feeding practices during the admission. RESULTS:There were 14,291 eligible participants including 11,612 (81%) who exclusively breastfed at discharge, and 2679 (19%) who did not. Statistically significant (p < 0.05) factors demonstrated a lower likelihood to exclusively breastfeed on discharge with higher maternal BMI (aOR = 0.96, 95% CI [0.95, 0.97]), not intending to breastfeed during the pregnancy (aOR = 0.07, 95% CI [0.06, 0.08]), smoking in pregnancy (aOR = 0.68, 95% CI [0.59, 0.79]), prior breast surgery (aOR = 0.84, 95% CI [0.71, 1.00]), not having midwifery-based antenatal care (aOR = 0.68, 95% CI [0.61, 0.76]), higher antenatal EPDS score (aOR = 0.97, 95% CI [0.96, 0.99]), Caesarean birth (aOR = 0.53, 95% CI [0.48, 0.60]), > = 60 minutes from birth to the first feed (aOR = 0.71, 95% CI [0.63, 0.80]), unplanned pregnancy (aOR = 0.88, 95% CI [0.78, 0.98]), birth weight < 2500 g (aOR = 0.51, 95% CI [0.39, 0.69]), nursery admission (aOR = 0.54, 95% CI [0.47, 0.62]) and no skin-to-skin at birth (aOR = 0.78, 95% CI [0.66, 0.92]). CONCLUSION:Considering these factors while designing breastfeeding interventions may allow for a more targeted and person-centered approach.
BACKGROUND:Human milk is a dynamic biofluid influenced by maternal health, diet, and environmental exposures, including cannabis consumption. OBJECTIVE:To synthesize current evidence on whether maternal cannabis consumption is directly associated with alterations in the macronutrient and immunological composition of breastmilk, and to identify dietary patterns and social adversity as key confounding variables requiring methodological consideration in future research. METHODS:A narrative review of the peer-reviewed literature was conducted. Relevant studies were identified using selected keywords searched individually and in combination. Search was not restricted by date but prioritized recent literature, with seminal studies included where relevant. Studies were selected based on relevance to the review questions; no formal inclusion or exclusion criteria were applied, consistent with the narrative review methodology. RESULTS:Maternal diet is a key determinant of breastmilk composition, particularly for fatty acids. Emerging evidence suggests that cannabis consumption may be associated with alterations in fat and protein concentrations, and may affect immune components such as Secretory Immunoglobulin A (SIgA). However, these associations may be confounded by cannabis-related changes in dietary patterns and by socioeconomic disadvantages that influence maternal nutrition and health. Findings remain limited and inconsistent, and underlying biological mechanisms remain poorly understood. CONCLUSIONS:Current evidence on the impact of maternal cannabis use on breastmilk composition is sparse and inconclusive. Further research is needed to disentangle the direct effects of cannabis exposure from related dietary and social determinants to clarify implications for infant growth, immune development, and long-term health outcomes.
Iran established its first human milk bank (HMB) in 2016 to address high rates of neonatal mortality and prematurity-related complications. A national network of 19 HMBs was developed using a sustainable model that integrated local technological innovation and religious consensus. By partnering with domestic knowledge-based companies to manufacture automated pasteurizers, the program successfully bypassed international trade sanctions that made imported equipment cost-prohibitive. Furthermore, the program secured official Fatwas from high-ranking Shia authorities and a formal letter of consent from the Urmia Sunni Clergy Council to resolve "milk kinship" concerns across diverse religious regions. By 2024, the network reached an annual collection volume of over 6,785 liters, serving thousands of infants. This sustainable model provides a practical blueprint for other resource-limited and Muslim-majority countries to enhance neonatal outcomes by ensuring equitable access to donor human milk through national coordination and cultural integration.
PROBLEM:This study was designed to test the effectiveness of the application of extra virgin coconut oil (EVCO) versus highly purified anhydrous (HPA) lanolin in preventing nipple pain and cracking with the goal of preventing subacute lactation mastitis in breastfeeding women during the first 6 weeks postpartum. METHOD:Randomized controlled study design using random assignment was conducted in a large urban hospital in the southern part of the United States. PROCEDURE:Participants assigned to the control group received the standard postpartum breast care cream-HPA lanolin-to prevent nipple pain and cracking while the other group was assigned to receive the experimental product of EVCO for breast care. Both products were dispensed by the research pharmacist prior to hospital discharge following an uncomplicated singleton birth. Measures of study variables were completed at baseline, 1 week, 3 weeks, and 6 weeks postpartum using the Storr Nipple Tenderness Scale (NTS) and the Numeric Pain Rating Scale (NPS). RESULTS:A total of 97 participants agreed to participate in the study, and 47 were enrolled. Due to high attrition, only 27 participants completed the full 6 weeks of the study. This early work suggests that EVCO was more effective than HPA lanolin in preventing nipple trauma and cracking (p < 0.001). CONCLUSION:Study findings suggest that EVCO should be considered as a frontline treatment for aid in preventing subacute lactation mastitis.
BACKGROUND:Breastfeeding women often experience nipple pain, usually caused by incorrect newborn positioning in the first 10 days after childbirth. AIM:To explore the efficacy and safety of a novel gel-based formulation in healthy pregnant and lactating women with cracked and painful nipples. METHOD:Sixty participants were instructed to gently apply approximately 0.5 g of test product onto the nipples and surrounding area for 14 days (an open-label, single-arm study). Nipple pain, nipple skin physical parameters, skin hydration, and skin barrier function were assessed at various time points. RESULTS:The nipple pain significantly reduced at all visits following the application of the test product, with a 43.7% decrease by 24 hours (Day 2; p < 0.0001) and a complete relief at Day 14 (p < 0.0001) after application of the test product compared to the baseline. The dermatological assessment of nipple skin conditions revealed a significant improvement in dryness, nipple skin roughness, nipple skin redness/erythema, burning, itching, and stinging at all visits compared to the baseline. Skin hydration significantly improved by 23.55% by 24 hours (p < 0.0001) and 42.25% at Day 14 (p < 0.0001) as compared to baseline. Additionally, trans-epidermal water loss (TEWL) significantly reduced by 8.78% by 24 hours (p < 0.0001) and 21.52% at Day 14 (p < 0.0001) as compared to baseline. CONCLUSION:The gel-based formulation was well-tolerated and safe, with participants showing marked improvement in nipple symptoms within 24 hours and complete resolution by Day 14. These findings are preliminary and further controlled studies are needed to confirm the results.Clinical trial registry name:Clinical Trials Registry-IndiaURL:www.ctri.nic.in. REGISTRATION NUMBER:CTRI/2022/08/044645.
INTRODUCTION:Flecainide is a class 1c antiarrhythmic drug used to manage ventricular and supraventricular arrhythmias. Its use in women of childbearing age is limited due to concerns about adverse outcomes. However, existing data suggest that flecainide may be safely used during pregnancy for maternal and neonatal arrhythmias. Its pharmacokinetic properties allow placental and breastmilk passage, but data on neonatal exposure via lactation remain scarce. This case report investigates the safety of maternal flecainide use during breastfeeding by analysing clinical and biochemical data in one nursed infant. METHODS:A 33-year-old primigravida with a history of right ventricular outflow tract tachycardia was maintained on flecainide 200 mg/day throughout pregnancy and lactation. The infant, delivered at term with no complications, was exclusively breastfed initially and later received a reduced volume. RESULTS:The infant underwent clinical and biochemical evaluations and ECG monitoring at 5, 7, and 30 days postpartum. All assessments, including heart rate, rhythm, and QT intervals, remained within normal ranges. Maternal plasma flecainide levels were within the therapeutic range. Despite significant flecainide concentrations in breastmilk, neonatal plasma levels remained below the lower limit of detection, and no adverse effects were observed.Relative infant dose calculations remained under the recommended 10% threshold. CONCLUSION & DISCUSSION:This case report supports the safe use of flecainide during lactation. Despite detectable flecainide in breastmilk, infant exposure remained subclinical. These findings align with prior case studies. Clinicians may safely recommend breastfeeding in the case of maternal flecainide use.
BACKGROUND:Breastfeeding challenges are common in postnatal settings, particularly in low-resource communities. Timely and skilled support by frontline workers such as Auxiliary Nurse Midwives (ANMs) and Community Health Officers (CHOs) is essential. RESEARCH AIM:This study was conducted to develop and validate a structured Objective Structured Clinical Examination (OSCE) based tool-LactManage-to assess the skills of frontline workers in managing breastfeeding problems at the community level. METHOD:A prospective, three-phase study was conducted from January to June, 2024. In Phase 1, a rigorous literature review including, national programs and the World Health Organization's 10 steps to successful breastfeeding, was performed to develop 10 OSCE stations covering key breastfeeding challenges. In Phase 2, content validity was assessed by 20 experts, and face validity by 30 lay experts. In Phase 3, construct validity was assessed using the final tool administered to 85 frontline health workers in the community setting. Content and face validity indices at item and scale level, along with kappa, were calculated. Construct validity was assessed using the Intraclass Correlation Coefficient and a known-groups t-test. RESULTS:The tool demonstrated high content (S-CVI/Avg = 0.92) and face validity (S-FVI/Avg = 0.99). The values of the Intraclass Correlation Coefficient had a range from 0.75 to 0.99 which is suggestive of good to excellent reliability. CHOs had significantly higher scores than ANMs in the known-groups t-test (p < 0.001) which supports construct validity. CONCLUSION:Our study concluded that the LactManage tool is valid and reliable for assessing the skills of the frontline workers on management of breastfeeding problems.
BACKGROUND:Public breastfeeding is influenced by social norms, cultural perceptions, and personal comfort, yet there is a lack of standardized instruments to assess societal attitudes toward breastfeeding in public spaces. RESEARCH AIM:To develop and validate the Maternal Attitudes toward Breastfeeding in Public Scale (MABPS), an instrument designed to assess mothers' perceptions of societal attitudes toward their own breastfeeding in public spaces. METHODS:The cross-sectional validation study was conducted with a sample of 320 breastfeeding women in Turkey. The development process included: (i) conceptual framework formulation based on an extensive literature review, (ii) content validity assessment by experts in maternal and child health, (iii) construct validity using Exploratory and Confirmatory Factor Analyses (EFA & CFA), (iv) internal consistency analysis via Cronbach's Alpha, and (v) reliability assessment via Split-half and item analysis. RESULTS:The final version of the MABPS consists of three subdimensions: (1) Breastfeeding Comfort in Public, (2) Support for Breastfeeding, and (3) Barriers to Public Breastfeeding. Factor loadings ranged from 0.56 to 0.84 and the model fit indices (CFI = 0.930, TLI = 0.912, RMSEA = 0.069) indicated good construct validity. Internal consistency was high (Cronbach's Alpha = 0.859). CONCLUSION:The MABPS is a valid and reliable instrument for assessing public attitudes toward breastfeeding in social spaces. This tool can support policy-making, social interventions, and awareness campaigns to normalize and promote public breastfeeding.
BACKGROUND:Breastfeeding remains the recommended feeding method during public health emergencies; however, pandemic-related restrictions created new challenges for mothers and their healthcare teams, including lactation professionals (LPs). The COVID-19 pandemic may have heightened LPs' occupational stress and limited their ability to provide lactation support. RESEARCH AIMS:This study examined occupational stress among LPs, identified stressors and coping strategies, and explored how pandemic-related workplace policies influenced lactation services. METHODS:A mixed-methods design was employed. A cross-sectional online survey assessed the experiences of hospital- and clinic-based LPs during the COVID-19 pandemic. Key informant interviews were conducted to identify stressors, coping strategies, and service delivery impacts. Descriptive and inferential statistics were conducted, and qualitative data were analyzed using reflexive thematic analysis. RESULTS:The sample included 1,373 healthcare professionals. Most LPs (91.8%) reported moderate to high perceived stress consistent with other studies. Key stressor themes included new policy implementation, evolving personal protective equipment requirements, employment changes, the transition to telehealth, and fear of infection. Participants reported using problem management, emotional regulation, and meaning-based coping strategies. Themes describing impacts on lactation service provision included reduced or delayed support, protected breastfeeding practices, hindered interpersonal connectedness, and telehealth limitations. Clinical policy changes were perceived to both hinder and improve lactation services. CONCLUSIONS:During public health emergencies, LPs-especially those with dual role responsibilities-require additional support. Interventions should build upon coping strategies identified in this study. Future research should examine how stressors influence service provision, the effectiveness of coping strategies, and the potential role of geographic context in policy implementation.
BACKGROUND:Paternal postnatal sense of security, referring to fathers' perceptions of role clarity, emotional reassurance, and support during the postpartum period, may be relevant to their active involvement in infant care and their influence on breastfeeding practices. METHODS:This cross-sectional correlational study included 103 fathers whose partners were in the early postpartum period. Data were collected using a personal information form, the Paternal Postnatal Sense of Security Scale, and the Partner Breastfeeding Influence Scale. Pearson and Spearman's rho correlations were used to examine relationships between variables. A two-step hierarchical regression assessed whether paternal postnatal sense of security was independently associated with breastfeeding influence and support behaviors after controlling for educational level and income status. RESULTS:Paternal postnatal sense of security was positively associated with breastfeeding influence and support behaviors. Hierarchical regression showed that postnatal sense of security was significantly and independently associated with breastfeeding influence and support behaviors (B = 1.89, β = .33, p < .001), explaining an additional 9.4% of the variance beyond sociodemographic variables: ΔR2 = .094, F-change(1, 97) = 12.30, p < .001. Spearman's rho indicated that longer mutually planned breastfeeding duration was associated with higher postnatal sense of security. CONCLUSION:A stronger postnatal sense of security among fathers is associated with greater involvement in breastfeeding support. These findings highlight the need to include fathers in postpartum care and breastfeeding education. Further longitudinal and intervention studies are needed to clarify how paternal postnatal sense of security relates to breastfeeding outcomes.
BACKGROUND:Mothers of late preterm infants need support with breastfeeding. AIM:The aim of this study was to examine the effect of Telephone Breastfeeding Support (delivered via telephone calls and WhatsApp messages) given to mothers of late preterm infants discharged from the neonatal intensive care unit (NICU) on breastfeeding outcomes. METHODS:The study was a single-blind, pretest-posttest, randomized, parallel two-group, controlled experimental study. The study involved 62 mothers in a NICU from August 2021 to August 2022. After all late preterm infants participating in the study completed their routine discharge procedures, pre-intervention data were collected from their mothers, and a breastfeeding guide was sent to their phones. The intervention group (n = 31) received breastfeeding support through WhatsApp and phone calls for 16 weeks. Posttests were taken when the infant was 6 months old. Data were collected using the mother-infant information form, the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), the Iowa Infant Feeding Attitude Scale (IIFAS), and the breastfeeding duration assessment form. RESULTS:When the infant reached 6 months, no statistically significant differences were found in inter- or intra-group BSES-SF scores, nor in inter-group IIFAS scores (p > 0.05). In the intragroup analysis, the intervention group showed a statistically significant improvement in pre- and post-intervention IIFAS scores (p < 0.05), while a significant difference was also observed between groups in breastfeeding cessation rates (p < 0.05). CONCLUSION:Telephone breastfeeding support has been shown to improve infant feeding attitudes and increase breastfeeding maintenance. Telephone breastfeeding support can be safely implemented for mothers of late preterm infants.
BACKGROUND:The KK Human Milk Bank provides pasteurized donor human milk to vulnerable infants across Singapore who lack sufficient mothers' own milk. However, donors and their designated family members were previously limited to depositing frozen milk only during office hours, creating inconvenience and restricting timely access. These challenges were amplified during the COVID-19 pandemic, when hospital entry limitations and concerns about viral exposure further discouraged on-site milk drop-offs. OBJECTIVE:To develop a contactless, round-the-clock milk depot that enables donors to securely deposit frozen milk without entering the hospital, thereby improving accessibility and supply resilience. METHODS:Key design considerations included safety, security, cost-effectiveness, and ease of access. A custom-built, multi-compartment freezer-locker system was developed featuring individual Personal Identification Number access, continuous closed-circuit television surveillance, and real-time temperature monitoring with automated malfunction alerts. The depot was strategically located for 24-hour accessibility. RESULTS:Launched on November 14, 2022, the system comprises 12 independent freezer compartments, each capable of maintaining frozen storage conditions and enabling secure, traceable milk deposits. Donor feedback has been highly positive, with 100% user satisfaction reported among depot users. CONCLUSION:The freezer-locker milk depot provides a secure, contactless, and continuously accessible solution for donor milk deposits. This innovation supports both donor convenience and operational resilience, ensuring uninterrupted milk supply during pandemics or other service disruptions.
BACKGROUND:Human milk banks play a critical role in neonatal care by providing donor human milk when maternal milk is unavailable, particularly for preterm and medically vulnerable infants. Despite global expansion, long-term evaluations of discard rates and quality indicators remain limited. RESEARCH AIM:To assess discard rates due to nonconformities, temporal trends in quality indicators, and nutritional characteristics of donor human milk processed in a tertiary-care milk bank over a 10-year period. METHODS:This retrospective longitudinal study analyzed routinely collected data from a Brazilian tertiary-care human milk bank between January 2014 and December 2023. Outcomes included collected and pasteurized milk volumes, and discard reasons: labeling, storage, packaging, physical contaminants, acidity ≥ 8°D, and microbiological positivity (BGBL+). Nutritional quality was evaluated using crematocrit-derived caloric classification. Temporal trends were examined using linear regression. RESULTS:Over the study period, 11,758.2 L of milk were collected and 7,851 L pasteurized. A total of 387.2 L (3.3%) was discarded due to nonconformities. Storage-related issues accounted for most losses (56.2%), followed by microbiological positivity (21.9%). Overall, discard rates remained low and stable (p = .924). Labeling errors declined (p = .044), while physical contaminants (p < .001) and microbiological positivity increased (p = .032). Dornic acidity exceeded thresholds in only 0.04% of samples. Among 47,919 pasteurized bottles, caloric composition remained stable: 54.7% normocaloric, 39.7% hypercaloric, 5.6% hypocaloric. CONCLUSIONS:Standardized quality-control procedures were associated with consistently low discard rates and stable nutritional quality. Improving cold-chain logistics and microbiological monitoring may further reduce losses and enhance donor milk availability.
BACKGROUND:Breast milk is a critical component of neonatal care, particularly for preterm infants, as it offers immunological and developmental benefits. Sustaining lactation during prolonged Neonatal Intensive Care Unit (NICU) stays remains a significant challenge for many mothers. AIM:To evaluate the impact of the Lactation Advocacy Through Continuous Help (LATCH) pilot program, a medical student-led initiative to provide ongoing lactation support in the NICU. METHODS:This was a single-center quality improvement study conducted over a 2-year period (2023-2024). Medical Students, who were Certified Lactation Counselors (CLC), met with new mothers weekly to support their lactation journey. Outcomes were assessed through participant surveys and breast milk intake data. Data were analyzed with unadjusted chi-square tests and odds ratios using SPSS (version 30); adjustments for potential confounders were not performed. RESULTS:Of the 198 eligible mothers (241 infants), 127 mothers (158 infants) enrolled in the program. By Days 8-14 of life, a significantly higher proportion of infants whose mother participated in the program received ≥ 50% mother's own milk compared to non-participants (87% vs. 65%, p < .001). Additionally, these infants were more likely to be receiving breast milk at discharge. Survey feedback indicated high satisfaction, with participants emphasizing emotional support and accessibility as key benefits. CONCLUSION:This program significantly increased the amount of breast milk infants received during Days 8-14 and showed a trend towards increased breastmilk at discharge. Integrating trained medical students into lactation support efforts not only enhances neonatal care by empowering mothers, it also provides valuable lactation education and clinical experience for medical students.
BACKGROUND:Milk secretion following abortion or fetal loss in the second trimester is common and can be physically and emotionally challenging. To date, research surrounding lactation after loss has focused on those experiencing a third trimester stillbirth or loss of an infant. RESEARCH AIM:To explore lactation counseling and support in the unique care setting of second trimester abortion or fetal loss patients. METHODS:This was a qualitative study involving semi-structured interviews with nine providers and community partners who intersect with second trimester abortion and fetal loss patients, recruited at an academic medical center in the northeast United States. Thematic analysis was used to identify and interpret meaningful patterns across the dataset. RESULTS:Five themes were identified: (1) Lactation guidance in the second trimester should be tailored to unique patient characteristics, (2) Varying care scenarios for second trimester abortion and fetal loss dictate the feasibility of offering lactation guidance, (3) An educational brochure would help second trimester abortion and fetal loss patients access necessary lactation information at their desired timing, (4) Providers feel they could benefit from more information on lactation in the second trimester, (5) While donation of milk by patients undergoing second trimester abortion and fetal loss was rare, stakeholders perceived the experience as positive for patients who chose to do it. CONCLUSION:Diverse patient scenarios and time-sensitive care schemes are important considerations for lactation options counseling in the second trimester. Distribution of an informational brochure, coordination between departments, and educational opportunities for providers can enhance lactation support in the second trimester.
BACKGROUND:Implementation of the strong recommendation by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and others, to increase use of donor human milk in cases where breastfeeding cannot be provided, requires a flexible, knowledge-based and risk-informed approach. METHODS:Based on an extensive literature review, we present the evidence for potential biological risks of breastmilk in three scenarios: fresh, unmodified milk from breast to baby (breastfeeding and wet-nursing); expressed and unmodified milk stored at < 4 ºC until just before consumption; and milk modified by some form of pasteurization. RESULTS:With the exception of contamination by some viruses and syphilis, breastfeeding is the safest way to feed a baby, despite its highly variable microbiome and virome-including organisms that, in other circumstances, can cause disease. Wet-nursing, where the donor has been appropriately screened, carries a similar risk profile to mother's own feeding. Whilst expression and storage of raw milk at < 4 °C adds a bacterial load, the additional risk, with knowledge and screening of the donor and careful attention to all steps in delivery, seems small and is smaller than using bovine-based formulae-especially in low resource circumstances. Donated milk from unknown donors carries additional risks. A decision to reduce these risks through thermal pasteurization must be weighed against the loss of breastmilk's natural protective components. CONCLUSIONS:Not only have the biological risks of both informal and formal milk sharing for healthy infants been greatly exaggerated, but that they are often quoted without consideration of the overall risks of alternatives.
BACKGROUND:Intergenerational influences on infant feeding are widely recognized across disciplines, yet the concept of intergenerational legacies in lactation decision-making remains inconsistently defined in the literature. Terms such as "intergenerational transmission," "generational influence," "grandmother support," and "cultural transmission" are used interchangeably without conceptual precision. For African American women, intergenerational legacies carry the additional weight of American enslavement, forced wet nursing, and structural racism, adding distinct dimensions that have not been formally analyzed. RESEARCH AIM:The purpose of this concept analysis is to identify the defining attributes, antecedents, and consequences of intergenerational legacies in lactation decision-making. METHODS:Walker and Avant's eight-step framework guided this analysis. An interdisciplinary literature search was conducted across PubMed, CINAHL, PsycINFO, Embase, and Scopus for peer-reviewed articles published in English from 2000 through 2025, spanning nursing, public health, anthropology, sociology, and family science. RESULTS:Three defining attributes were identified: (1) intergenerational transmission of lactation knowledge and beliefs, (2) historical and cultural context shaping feeding perceptions, and (3) adaptive responses across generations. Model, borderline, related, and contrary cases illustrate the concept's boundaries. Antecedents include multigenerational family structures, previous generations' feeding experiences, intergenerational communication pathways, and the historical context of enslavement. Consequences include shaping of maternal feeding attitudes, influence on lactation self-efficacy, and perpetuation or disruption of feeding norms. CONCLUSIONS:This analysis provides the first formal definition of intergenerational legacies in lactation decision-making, offering a theoretical foundation for culturally responsive research and practice across populations, with particular application to communities shaped by historical disruption of intergenerational knowledge transmission.
