Sunday, 24 July 2011

Breastfeeding: A Literature Review Paper

Literature Review


The World Health Organization (WHO) recommends that women breastfeed their children for 2 years and that children have only breast milk for their first 6 months of life (WHO, 2003). Health care professionals are challenged to promote breastfeeding  because, “Breast milk is widely acknowledged to be the most complete form of nutrition for infants, with a range of benefits for infants’ health, growth, and development” (WHO, 2003, p. 3). Moreover, breastfeeding improves maternal health long after the postpartum period (CDC). Health promotion requires high health behavior confidence (Hausman, 2003 and Rodriguez-Palmero, Koletzko, Kunz, Jensen, 1999).



Breastfeeding Mothers

Most women have a plan about breastfeeding before they conceive (Baumslag & Michels, 1995; Leeson, Kattenhorn, Deanfield, Lucas 2001; and Stuebe, Michels, Willett, Manson, Rexrode, & Rich-Edwards, 2009). A woman whose preconception plan is not to breastfeed and who changes her mind prenatally is likely to quit breastfeeding earlier and more easily than a woman whose preconception plan is to breastfeed (Torgus & Gotsch, 2004 and Spatz, 2006). The development of research instruments with satisfactory psychometric properties to measure breastfeeding confidence is necessary before randomized clinical trials of interventions to increase confidence can be conducted and effectively evaluated. To date, no studies have used a randomized clinical trial design to evaluate the effect of interventions on the breastfeeding confidence of women.

The instrument known as Breastfeeding Personal Efficacy Beliefs Inventory measures breastfeeding confidence to predict breastfeeding initiation and duration the first year after giving birth (Bartick & Reinhold, 2010). On the other hand, the Breastfeeding Self-Efficacy Scale (Torres, Torres, Rodriguez, & Dennis, 2003) measures breastfeeding confidence after breastfeeding is initiated to predict women’s breastfeeding perseverance up to 6 weeks after giving birth. Because the purposes of the instruments are different, their confidence assessments are different. For example, women’s confidences about their capability to breastfeed for 3 months, 6 months, and 1 year, and their capability to breastfeed in diverse environments are assessed in the instrument reported here. The Torres, et al. (2003) instrument assesses more deeply women’s confidence about their capability to manage breastfeeding’s initial techniques and challenges. Understanding women’s confidence about accomplishing all aspects of breastfeeding in all circumstances will assist health care professionals in meeting the challenge of promoting breastfeeding.


Breastfeeding Statistics

Although breastfeeding was initiated by 69% of mothers in the United States, after 6 months, only 29% of babies were receiving breast milk (Picciano, 2001). The United States government and multiple health professional organizations recommend breastfeeding for 1 year. In the paper of Kramer & Kakuma (2002), they calls for 75% of women to breastfeed after birth and for 50% of women to be breastfeeding at 6 months after birth. These goals do not specify amounts of the child’s diet that should be breast milk. However, in 1990, standard research definitions for amount of diet provided by breast milk were established (Agostoni & Haschke 2003 and Der, Batty, Deary, 2006). A full breast milk diet is exclusively, or almost 100%, breast milk. Partial breast milk diets consist of high, which is above 80%, medium, which is 79% to 20%, and low, which is below 20%. Token breastfeeding makes an insignificant caloric contribution to the child’s diet (Pryor, 1997).

Older and more educated women and those that live in the Western United States have been more likely to breastfeed (Pryor, 1997 and Vennemann, Bajanowski, Brinkmann, Jorch, Yücesan, Sauerland, Mitchell (2009). Currently, many women are discouraged from breastfeeding because of diminished confidence. Successful practice before pregnancy and birth is hindered by breastfeeding’s physiology. It is difficult to practice a behavior that requires hormonal readiness and a child. Successful role modeling of breastfeeding is hindered because of the low occurrence of breastfeeding in the United States. Successful verbal persuasion about breastfeeding is negatively impacted by the discomfort that many people feel at the sight of a child breastfeeding. Many breastfeeding women experience rudeness from others both in public and at home (Huggins, 1999). Often, women who are from the older generation do not encourage women who are younger to breastfeed. This is important because, in traditional areas of the country, older women influence the health behavior of their extended families (Kunz, Rodriguez-Palmero, Koletzko& Jensen, 1999). Finally, achieving a comfortable physiological state with breastfeeding is hindered by the lack of breastfeeding knowledge. Information about how to put the child to breast, how to get assistance with the child, and methods of increasing and decreasing milk supply have been lost to the general public because of years of low breastfeeding rates.

Instruments that measure personal efficacy beliefs have been developed by multiple researchers to promote other health behaviors, to increase self-management of disease, to improve academic achievement, and to counsel about career choice (Horwood, Darlow, Mogridge, 2001 and Armstrong & Reilly 2002). To date, there is no instrument that measures women’s breastfeeding personal efficacy beliefs other than after breastfeeding is initiated.



Agostoni C, Haschke F (2003). “Infant formulas. Recent developments and new issues”. Minerva Pediatr 55 (3): 181–94.

Armstrong J, Reilly JJ (2002). “Breastfeeding and lowering the risk of childhood obesity”. Lancet 359 (9322): 2003–4.

Bartick M & Reinhold A (2010). “The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis”. Pediatrics 125.

Baumslag N & Michels DL (1995). Milk, money, and madness: the culture and politics of breastfeeding. Westport, Conn.: Bergin & Garvey. ISBN 0-89789-407-3.

Der G, Batty GD, Deary IJ (2006). “Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis”. BMJ 333 (7575): 945.

Hausman B (2003). Mother’s milk: breastfeeding controversies in American culture. New York: Routledge. ISBN 0-415-96656-6.

Horwood LJ, Darlow BA, Mogridge N (2001). “Breast milk feeding and cognitive ability at 7-8 years”. Arch. Dis. Child. Fetal Neonatal Ed. 84 (1): F23–7.

Huggins K (1999). The nursing mother’s companion (4th ed.). Boston, Mass.: Harvard Common Press. ISBN 1-55832-152-7.

Kramer M & Kakuma R (2002). “Optimal duration of exclusive breastfeeding”. Cochrane Database Syst Rev (1).

Kunz C, Rodriguez-Palmero M, Koletzko B, Jensen R (1999). “Nutritional and biochemical properties of human milk, Part I: General aspects, proteins, and carbohydrates”. Clin Perinatol 26 (2): 307–33.

Leeson C, Kattenhorn M, Deanfield J, Lucas A (2001). “Duration of breast feeding and arterial distensibility in early adult life: population based study”. BMJ 322 (7287): 643–7.

Picciano M (2001). “Nutrient composition of human milk”. Pediatr Clin North Am 48 (1): 53–67.

Pryor G (1997). Nursing mother, working mother: the essential guide for breastfeeding and staying close to your baby after you return to work. Boston, Mass.: Harvard Common Press. ISBN 1-55832-116-0.

Rodriguez-Palmero M, Koletzko B, Kunz C, Jensen R (1999). “Nutritional and biochemical properties of human milk: II. Lipids, micronutrients, and bioactive factors”. Clin Perinatol 26 (2): 335–59.

Spatz D (2006). “State of the science: use of human milk and breast-feeding for vulnerable infants”. J Perinat Neonatal Nurs 20 (1): 51–5.

Stuebe AM, Michels KB, Willett WC, Manson JE, Rexrode K, Rich-Edwards JW (2009). “Duration of lactation and incidence of myocardial infarction in middle to late adulthood”. Am J Obstet Gynecol 200 (2): 138.e1–8.

Torgus J, Gotsch G (2004). The womanly art of breastfeeding (7th ed.). Schaumburg, Ill.: La Leche League International. ISBN 0-912500-98-0.

Torres, MM Torres, RRDRodriguez, AMP & Dennis CL (2003). Translation and Validation of the Breastfeeding Self-Efficacy Scale Into Spanish: Data From a Puerto Rican Population. J Hum Lact, 19(1): 35 – 42.

Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Yücesan K, Sauerland C, Mitchell EA; GeSID Study Group (2009). “Does breastfeeding reduce the risk of sudden infant death syndrome?”. Pediatrics 123 (3): e406–10.

World Health Organization. (2003). Global strategy for infant and young child feeding. Geneva, Switzerland: World Health Organization and UNICEF. ISBN 9241562218. Retrieved 2010-09-23.

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