Medicine and Health Sciences Commons^™

Impact Of Baby Friendly On Exclusive Breastfeeding: Befriending Baby Friendly, Constance Z. Townson

MSN Capstone Projects

Unless you have personally breastfed a newborn baby or tried to help a struggling breastfeeding mother, chances are you would think breastfeeding is not only natural but comes easily. Breastfeeding is indeed a natural progression following delivery; however, various things can play a role in the success of a mother and newborn baby trying to breastfeed. Issues such as feeding position, waking a sleepy newborn, mothers not recognizing newborn hunger cues, a full day of well-meaning visitors impeding skin-to-skin time with mom, or delayed feedings are just a handful. Sometimes, breastfeeding is so difficult that moms who want to breastfeed …

The Impact Of Kangaroo Care On Exclusive Breastfeeding In Premature Infants, Colleen Larue

MSN Capstone Projects

This benchmark project emphasizes the crucial imperative of promoting exclusive breastfeeding among preterm and low birth weight infants in neonatal intensive care units (NICUs). Despite the well-documented benefits, exclusive breastfeeding rates remain disappointingly low. This evidence-based project focuses on early intervention through kangaroo care to bolster exclusive breastfeeding rates, with the overarching aim of enhancing infant outcomes and mitigating risks of mortality and morbidity. Engaging key stakeholders, including NICU leadership, nursing staff, lactation consultants, and families, is paramount for the successful implementation of the program. The project presents a detailed implementation plan encompassing various phases, from admission procedures to sustainability …

Study Protocol For A Stepped-Wedge Cluster (Nested) Randomized Controlled Trial Of Antenatal Colostrum Expression (Ace) Instruction In First-Time Mothers: The Ace Study, Cassandra Cuffe, Roslyn Giglia, Matthew N. Cooper, Julie Hill, Desiree Silva, Anita M. Moorhead, Valerie Verhasselt, Joshua R. Lewis, Deborah Ireson, Jill R. Demirci, Talea Cotte, Kathryn Webb, Frances Patey, Therese A. O’Sullivan

Research outputs 2022 to 2026

Background: Although many mothers initiate breastfeeding, supplementation with human-milk substitutes (formula) during the birth hospitalization is common and has been associated with early breastfeeding cessation. Colostrum hand expressed in the last few weeks before birth, known as antenatal colostrum expression (ACE), can be used instead of human-milk substitutes. However, evidence is lacking on the efficacy of ACE on breastfeeding outcomes and in non-diabetic mothers. Methods and Planned Analysis: This multicenter stepped-wedge cluster (nested) randomized controlled trial aims to recruit 945 nulliparous pregnant individuals. The trial is conducted in two phases. During Phase 1, control group participants are under standard care. …

World Allergy Organization (Wao) Diagnosis And Rationale For Action Against Cow's Milk Allergy (Dracma) Guidelines Update – X – Breastfeeding A Baby With Cow's Milk Allergy, Vicki Mcwilliam, Merryn Netting, Evelyn Volders, Debra Palmer, Ignacio Ansotegui, Stefania Arasi, Amal H. Assa'ad, Sami L. Bahna, Antonio Bognanni, Rose Kamenwa

Paediatrics and Child Health, East Africa

Cow’s milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow’s milk allergy, it is critical to examine the evidence for and against any form of cow’s milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow’s milk proteins detectable in human milk cause infant cow’s milk allergy symptoms. Current clinical practice recommendations advise a 2–4 week trial of maternal cow’s milk dietary elimination for: a) IgE-mediated cow’s milk allergy only if …

Cognitive Aid For Anesthesia Providers Caring For Lactating Mothers, Danielle Pantella, Dana Lawrence

DNP Scholarly Projects

Evidence on the transfer of medications into breastmilk during the administration of anesthesia and sedation medications may not be well known by anesthesia providers. As they teach lactating mothers, anesthesia clinicians may not be comfortable explaining details about breastfeeding, such as the effects of anesthesia on breast milk and when mothers can safely resume breastfeeding. Lack of provider knowledge may be a safety threat that can be decreased by an evidence-based cognitive aid. The purpose of this patient safety project is to develop a cognitive aid that includes anesthetic agents and knowledge components to structure the provision of care to …

Effectiveness Of A Postpartum Breastfeeding Protocol For Avoiding Pregnancy, Mary Schneider, Richard J. Fehring, Thomas Bouchard

College of Nursing Faculty Research and Publications

The uses of cervical mucus and basal body temperature as indicators of return to fertility postpartum have resulted in high unintended pregnancy rates. In 2013, a study found that when women used urine hormone signs in a postpartum/breastfeeding protocol this resulted in fewer pregnancies. To improve the original protocol's effectiveness, three revisions were made: (1) women were to increase the number of days tested with the Clearblue Fertility Monitor, (2) an optional second luteinizing hormone test could be done in the evening, and (3) instructions were given to manage the beginning of the fertile window for the first six cycles …

Making Breastfeeding Easier With Clinician Support, Katherine Laney

MSN Capstone Projects

This benchmark project provides a template for how to implement clinician support and education in an organization with obstetric and pediatric clinics and a hospital based on the PICOT: In first-time breastfeeding mothers (P), how does clinician driven support and education during the perinatal period (I) compared to no clinician assistance (C) affect the rate of continued breastfeeding (O) within the first 3 months postpartum (T). Research demonstrates that increased clinician support and education provided to the mothers during the perinatal period increases breastfeeding rates and self-efficacy. The project would initially last for approximately 12 weeks and follow women from …

Lactation Support On Low-Income Women Exclusively Breastfeeding, Ashley Holmes, Kayla Lorenc, Morgan Ireland, Camryn Brown, Ashley M. Holmes

Non-Thesis Student Work

Low-socioeconomic-status new mothers who wish to exclusively breastfeed, face significant challenges associated with available resources, finances, and maternal leave. To address this issue, the authors explored the following evidence-based PICOT question: among low-socioeconomic-status new mothers that breastfeed, does access to lactation supports in the workplace, compared to no or limited access, affect their ability to exclusively breastfeed for the baby’s first six months? This project conducted a search of the literature in CINAHL and PubMed databases using the terms breastfeeding, low-socioeconomic-status, and workplace lactational support. Inclusion criteria included peer-reviewed articles published between 2017 to present, containing keywords/phrases …

Effect Of Antenatal Milk Expression Education On Lactation Outcomes In Birthing People With Pre-Pregnancy Body Mass Index ≥ 25: Protocol For A Randomized, Controlled Trial, Jill R. Demirci, Melissa Glasser, Debra L. Bogen, Susan M. Sereika, Dianxu Ren, Kristin Ray, Lisa M. Bodnar, Therese A. O'Sullivan, Katherine Himes

Research outputs 2022 to 2026

Background: Birthing people with pre-pregnancy body mass indices (BMIs) ≥ 25 kg/m2, particularly those without prior breastfeeding experience, are at increased risk for suboptimal lactation outcomes. Antenatal milk expression (AME) may be one way to counteract the negative effects of early infant formula supplementation common in this population. Methods: This ongoing, randomized controlled trial in the United States evaluates the efficacy of a telelactation-delivered AME education intervention versus an attention control condition on lactation outcomes to 1 year postpartum among 280 nulliparous-to-primiparous, non-diabetic birthing people with pre-pregnancy BMI ≥ 25 kg/m2. The assigned study treatment is delivered via four weekly …

Exclusive Breastfeeding Versus Formula Feeding: Evaluating The Development Of Childhood Allergies, Jasmine Olshin, Anna Kousky, Lily Williams, Michael Mark

Non-Thesis Student Work

Allergies such as dietary, allergic rhinitis, allergy-related asthma, and atopic dermatitis have become increasingly prevalent in childhood and pose a public health concern – especially as severe allergic reactions, such as anaphylaxis, are rising among children. Exclusive breastfeeding and formula feeding are two common infant feeding practices, but their role in influencing the development of childhood allergies are not entirely understood. Thus, the question is raised as to whether infants who are exclusively breastfed are at a decreased risk for developing childhood allergies, compared to infants who are formula fed. A literature search was conducted utilizing relevant databases PubMed, BioMed …

Increasing Nurse Awareness Of A Breastfeeding And Substance Use Disorder Guideline To Improve Rates Of Breast Milk And Skin To Skin Usage: A Quality Improvement Initiative​, Makenna R. Black, Alexandria L. Tasket, Megan L. Young, Tracy L. Brewer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Neonatal opioid withdrawal syndrome (NOWS) is related to opioid exposure in utero, and cases of NOWS have been increasing. In Tennessee in 2020, 824 newborns were born with NOWS. NOWS treatment involves pharmacological and nonpharmacological treatment. Breastfeeding, a nonpharmacological treatment, decreases the need and length for pharmacological treatment, the length of stay, and NOWS symptoms. Skin-to-skin may also reduce symptoms of NOWS. This quality improvement (QI) project involved implementing an Opioid Use Disorder Toolkit from the Tennessee Initiative for Perinatal Quality Care (TIPQC) and specifically educating staff nurses in a Women and Infant’s Department in a regional medical center on …

Design, Development, And Testing Of Best4baby, An Mhealth Technology To Support Exclusive Breastfeeding In India: Pilot Study., Tony Ma, Katie Chang, Amal Alyusuf, Elina Bajracharya, Yukiko Washio, Patricia J Kelly, Roopa M Bellad, Niranjana S Mahantashetti, Umesh Charantimath, Vanessa Short, Parth Lalakia, Frances J. Jaeger, Shivaprasad Goudar, Richard Derman

Department of Pediatrics Faculty Papers

Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries.

Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices.

Methods: A …

Knowledge And Practices On The Prevention And Management Of Diarrhea In Children Under-2 Years Among Women Dwelling In Urban Slums Of Karachi, Pakistan, Asif Khaliq, Amreen 1, Nazia Jameel, Stefanie J. Krauth

Department of Paediatrics and Child Health

Background: Diarrhea is the second leading cause of death especially among children. The age-proportionate mortality of diarrheal disease in infants under 2 years is 72%, among children under 5 years of age. Children living in urban slums are more prone to develop diarrhea. Although the disease can be prevented by many simple cost-effective interventions, i.e. proper sanitation and hygiene, appropriate feeding, and timely vaccination, poverty and lack of basic life amenities often potentiate diarrhea mortality. Gadap town is the largest town of Karachi with a deprived health system. This study aims to assess pediatric diarrhea prevalence and related knowledge-practice gaps …

Breastfeeding Awareness And Empowerment (Bae): A Black Women-Led Approach To Promoting A Multigenerational Culture Of Health, Rebecca Duncan, Jabina Coleman, Sharon Herring, Meg Kawan, Christy Santoro, Meghana Atre, Aleigha Mason, Shawana S Moore, Aparna Kumar

College of Nursing Faculty Papers & Presentations

(1) Background: Critical gaps in the U.S. healthcare system perpetuate adverse reproductive health outcomes for Black people. Grounded in reproductive justice and trauma-informed care, Breastfeeding Awareness and Empowerment (BAE) has developed a program titled BAE Cafe to directly address these gaps by providing community-based lactation and perinatal mental health support. A literature review identified key programmatic gaps, namely, access to knowledge relevant to troubleshooting breastfeeding, peer support, community support and healthcare system support, and system-level factors that impede families and communities from accessing lactation support. (2) Methods: This paper describes BAE Cafe through a group process observation and participant survey. …

Promoting Exclusive Breastfeeding Among Racing/Ethnic Minority Women For The First Six Months, Linda A. Boateng

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Breastfeeding is the recommended way of feeding infants due to the numerous health benefits. However, racial/ethnic minority women in the United States are less likely to initiate and maintain breastfeeding for the recommended six months compared to white women. This has resulted in higher health issues such as obesity, diabetes type I, allergic sensitivity, acute otitis media, and gastrointestinal problems among racial /ethnic minority children. Purpose: The purpose of this Quality Improvement Project was to promote exclusive breastfeeding among racial/ethnic minority postpartum mothers for the first six months. This was done by providing breastfeeding education to postpartum nurses …

Prenatal Perception Of Wic Breastfeeding Recommendation Predicts Breastfeeding Outcomes In Infant's First Year, Joanne Guthrie, Qi Zhang, Kelin Li, Kathryn Wouk, Rajan Lamichhane

Community & Environmental Health Faculty Publications

Objectives

Promoting breastfeeding (BF) is a priority of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior research found that pregnant mothers who believed WIC recommends BF only (versus BF and formula equally OK) were more likely to initiate BF and continue through 1 month postpartum. We examine whether such mothers are more likely to continue to exclusively BF through 5 months and BF at all through the infant's first year. Methods

Data are from the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a longitudinal study that includes 2,649 mothers who completed prenatal interviews. Four BF …

Analyzing The Relationship Between Breastfeeding And Postpartum Depression: An Integrative Review, Sarah K. Johnson

Doctoral Dissertations and Projects

Treating maternal mental health and identifying contributing factors are priorities in health care. Postpartum depression is a very prevalent and burdensome illness in the United States that negatively affects the health and well-being of postpartum mothers as well as their infants. While breastfeeding is known to be advantageous to both maternal and infant health, it may be implicated in the development of postpartum depression in some scenarios. The purpose of this integrative review is to examine the relationship between breastfeeding and postpartum depression to promote the best health outcomes for both the mother and the child with goals of determining …

Fathers’ Experiences Of Feeding Their Extremely Preterm Infants In Family-Centred Neonatal Intensive Care: A Qualitative Study, Evalotte Mörelius, Sofia Brogren, Sandra Andersson, Siw Alehagen

Research outputs 2014 to 2021

Background:

Extremely preterm infants need advanced intensive care for survival and are usually not discharged before they reach the time of expected birth. In a family-centred neonatal intensive care unit both parents are involved at all levels of care including the feeding process. However, studies focusing on fathers in this situation are scarce. The purpose of this study was to explore the experiences of feeding extremely preterm infants in a neonatal intensive care unit from fathers’ perspectives.

Methods:

The study adopts a qualitative inductive method, reported according to the COREQ checklist. Seven fathers of extremely preterm infants (gestational age 24–27 …

Improving Newborn Outcomes Through Implementation Of Delayed Bathing: An Integrative Review, Tennille Ideen O'Connor

Doctoral Dissertations and Projects

Evidence-based practice is foundational to ensuring patient safety and quality of care. Implementing evidence-based practice is the responsibility of all care providers. The completion of an in-depth integrative review provides a project leader the opportunity to explore the benefits of delayed bathing of the newborn and impact of the practice on newborn outcomes. The goal of this integrative review is to identify the benefits of delayed bathing and ways to implement this practice in the clinical setting. This integrative review seeks to present care providers with the most recent research and guidelines as it relates to the practice of delayed …

Dnp Final Report: Building A Comprehensive Guideline To Improve The Treatment Of Infants With Neonatal Abstinence Syndrome: An Evidence-Based Innovation Project, Cyndi B. Kelley

DNP Final Reports

Background: The incidence of Neonatal Abstinence Syndrome (NAS) has increased nationally; however, only 55% of NICUs indicated having a written NAS treatment plan as recommended by the American Association of Pediatrics. Current practice included symptom management via morphine only; however, non-pharmacological interventions were not routinely delivered.

Purpose: The purpose of this project was to standardize and improve the care provided to patients with NAS.

Methods: A systematic search was conducted using keywords and subject headings from the PICOT question. Retrieved synthesized evidence suggested that adding breastfeeding and rooming-in as first-line treatment options reduced the length of hospital stay and medication …

Evaluation Of A Text Messaging Intervention For Breastfeeding Women Experiencing Breast And Nipple Symptoms, Rose Lisi

Honors Scholar Theses

Background: Nipple and breast pain while breastfeeding is a common reason why women stop breastfeeding earlier than they would have liked to. Texting is effective as a long-term intervention to support breastfeeding.

Objectives: To examine the effect of texting to support mothers to manage their breast and nipple symptoms and pain.

Method: A secondary analysis of a pilot randomized controlled trial testing the effectiveness of a breastfeeding self-management (BSM) intervention using texting to provide strategies for mothers to manage their breast and nipple pain. A three-group comparison, the intervention group with “barriers” and “non-barrier”, and the control group, was conducted …

Preterm Babies Risk For Malnutrition, Shannon Lyons, Molly Mancini

Spring Showcase for Research and Creative Inquiry

Babies born prematurely can experience a variety of health issues. Preterm babies can develop “breathing problems, developmental delays, and vision problems” (“Preterm Birth”, 2019). On top of these issues, babies can also experience feeding difficulties. The purpose of this research study was to explore the effects of being preterm has on the ability to feed and risk of developing malnutrition compared to full-term babies. We will observe various studies on this, along with our own clinical experiences.

Breastfeeding Issues Leading To Early Cessation, Brandy Kirstein

DNP Research Projects

Breastfeeding has come to the forefront in modern research as a necessary and important phenomenon to understand and address due to the vast amount of evidence revealing its health benefits for both Mom and baby. Disparities exist related to socioeconomic status, education level, poverty, young age, obesity, alcohol use, smoking, and living in rural areas. This project aims to discover the areas that need the most awareness and change specific to the state of Tennessee to increase the prevalence of exclusive breastfeeding for six months (EBF6) creating healthier future generations and society. This project was a non-experimental, retrospective, correlational design, …

Metabolism During Pregnancy And Postpartum: How Does It Change And What Factors Influence It?, Kristin Yoho

Masters Theses & Specialist Projects

PURPOSE: Pregnancy is a physically impactful process in a woman’s life. During this time, a woman will gain weight and research has shown that many women will retain some extra weight after delivery. Because of this, recovery in the postpartum period is pivotal to avoiding the implications of weight retention. The postpartum period is vastly understudied in both the research and medical communities and this gap between pregnancy and postpartum research needs to be bridged. Therefore, the purpose of this study was to investigate metabolic changes from pregnancy to postpartum and to study how factors such as sleep and breastfeeding …

Impact Of Donor Milk On Short- And Long-Term Growth Of Very Low Birth Weight Infants, Rebecca Hoban, Michael E. Schoeny, Anita Esquerra-Zwiers, Tanyaporn K. Kaenkumchorn, Gina Casini, Grace Tobin, Alan H. Siegel, Kousiki Patra, Matthew Hamilton, Jennifer Wicks, Paula Meier, Aloka L. Patel

Faculty Publications

Mother’s own milk (MOM) reduces the risk of morbidities in very low birth weight (VLBW) infants. When MOM is unavailable, donor breastmilk (DM) is used, with unclear impact on short- and long-term growth. This retrospective analysis compared anthropometric data at six time points from birth to 20–24 months corrected age in VLBW infants who received MOM supplements of preterm formula (n = 160) versus fortified DM (n = 161) during neonatal intensive care unit (NICU) hospitalization. The cohort was 46% female; mean birth weight and gestational age (GA) were 998 g and 27.3 weeks. Multilevel linear growth models assessed changes …

The Impact Of Maternal Bmi, Gestational Weight Gain, And Breastfeeding On Early Childhood Weight: Analysis Of A Statewide Wic Dataset, Jennifer M. Ohlendorf, Karen Marie Robinson, Mauricio Garnier-Villarreal

College of Nursing Faculty Research and Publications

Early childhood obesity is a persistent health concern with more frequent and significant impact on low-income families. Maternal weight factors impact offspring weight status, but evidence on whether breastfeeding protects against this impact is mixed. This analysis examined a model to predict early childhood obesity risk, simultaneously accounting for maternal pre-pregnancy body mass index (BMI), gestational weight gain, and breastfeeding. The team analyzed 27,016 unique maternal-child dyadic records collected via the Supplemental Nutrition Program for Wisconsin Women, Infants, and Children (WIC) between 2009 and 2011. Generalized Linear Modeling, specifically logistic regression, was used to predict a child's risk …

Dissociation Between Cervical Mucus And Urinary Hormones During The Postpartum Return Of Fertility In Breastfeeding Women, Thomas Bouchard, Len Blackwell, Simon Brown, Richard Fehring, Suzanne Parenteau-Carreau

College of Nursing Faculty Research and Publications

Identifying the return of fertility with cervical mucus observations is challenging during the postpartum period. Use of urinary measurements of estrogen and progesterone can assist in understanding the return to fertility during this period. The purposes of this study were to describe the postpartum return of fertility by an analysis of total estrogen (TE) and pregnanediol glucuronide (PDG) profiles and to correlate these profiles with cervical mucus observations. Twenty-six participants collected urine samples during the postpartum period and recorded mucus scores. TE and PDG hormones were analyzed and compared with mucus scores. During amenorrhea, mucus reflected TE changes in only …

Trends And Factors Associated With Early Initiation Of Breastfeeding In Namibia: Analysis Of The Demographic And Health Surveys 2000–2013, M. N. Ndirangu, Samwel Gatimu, H. M. Mwinyi, D. C. Kibiwott

School of Nursing & Midwifery, East Africa

Background: Early initiation of breastfeeding (EIBF) lowers the risk for all-cause mortality in babies, including those with low birth weight. However, rates of neonatal mortality and delayed initiation of breastfeeding remain high in most low- and middle-income countries. This study aimed to assess the trends and factors associated with EIBF in Namibia from 2000 to 2013.

Methods: An analysis of EIBF trends was conducted using data from three Namibia Demographic Health Surveys. The present sample included singleton children younger than 2-years from 2000 (n = 1655), 2006–2007 (n = 2152) and 2013 (n = 2062) surveys. Descriptive statistics were used …

Education For Wic Peer Counselors About Breastfeeding The Late Preterm Infant, Cindi Faith Bennett, Cynthia Galloway, Jane S. Grassley

Nursing Faculty Publications and Presentations

Mothers of late preterm infants need ongoing support because they often find establishing breastfeeding (BF) to be complex and difficult. Special Supplemental Nutrition Program for Women, Infants and Children peer counselors provide BF information and emotional support to new mothers in many communities. However, their current training does not include education about BF for the late preterm infant. The purpose of this report is to present important information about BF and the late preterm infant that can enhance peer counselors' ability to offer appropriate support. The effect of this education on outcomes such as BF rates, maternal self-efficacy, infant …

Effectiveness Of An Online Natural Family Planning Program For Breastfeeding Women, Richard Fehring, Mary Schneider, Thomas Bouchard

College of Nursing Faculty Research and Publications

Objective To analyze the effectiveness of an online, nurse-managed natural family planning (NFP) program among breastfeeding women and subgroups of these women. Design Longitudinal comparative cohort study. Setting A university-based online NFP education program and menstrual cycle charting system. Participants Women (N = 816) with a mean age of 30.3 years (standard deviation = 4.5) who registered to use the online NFP system and indicated they were breastfeeding. Methods Participants tracked their fertile times with an electronic hormone fertility monitor (EHFM), cervical mucus monitoring, or both. All unintended pregnancies were evaluated by professional nurses. Results The correct use pregnancy rates …