How to Troubleshoot Apps for the Modern Connected Worker
J hum lact 2012-ilca 2011 abstracts-77-85
1. Journal of Human Lactation http://jhl.sagepub.com/
Abstracts of Research Oral and Poster Presentations at the 2011 ILCA Conference
J Hum Lact 2012 28: 77
DOI: 10.1177/0890334411428583
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3. 78 Journal of Human Lactation 28(1)
Background Background
Nurses play a crucial role in promoting breastfeeding. Studies Physician-mothers’ breastfeeding behavior is being studied
in Western countries have found inadequate breastfeeding because it is believed to affect their anticipatory guidance to
knowledge among undergraduate nursing students. their patients, which in turn influences patients’ breastfeeding
initiation and continuation.
Aim
Aims
To assess the breastfeeding knowledge, attitudes, perceived
adequacy of breastfeeding education, and self-confidence to To assess the breastfeeding practices of physician-mothers
provide breastfeeding support among baccalaureate nursing and their reasons for stopping breastfeeding.
students in Cairo, Egypt.
Methods
Method
The study was cross-sectional in design. A self-administered
An exploratory descriptive study used a convenience sample semistructured questionnaire was given to all registered 56
of baccalaureate nursing students from Cairo, Egypt. physician-mothers in government-owned primary, secondary,
Students who had completed maternal/child nursing didactic and tertiary health facilities, whose youngest child was aged
and clinical courses were eligible to participate. A sample of 5 years. Informed consent was obtained. Outcome measures
92 students completed the survey during spring 2009. The were time of initiation of breastfeeding, duration of exclusive
authors used the Breastfeeding Knowledge Questionnaire and continued breastfeeding, introduction of prelacteal food,
adapted from Brodribb et al (2008) to measure breastfeeding and reasons for stopping breastfeeding. Data were analyzed
knowledge and the Iowa Infant Feeding Attitude Scale to test using SPSS version 17.
students’ breastfeeding attitudes.
Results
Results
Fifty (89.3%) physicians responded; 70% of these initiated
Students’ ages ranged from 18 to 21 years (mean, breastfeeding within 1 hour after birth. Duration for exclusive
19.5 ± 1.2 years), with 75% female students. The mean breastfeeding was ≥6 months in 28.6%, >6 months in 71.4%
breastfeeding knowledge score was 12.41 points out of 24, of which 8% did not breastfeed exclusively, 37% continued
which represents 52% of the total score. The attitudes mean breastfeeding for <15 months, whereas 26.1%, 26.1% ,and
score was 3.13 ± 0.64. There was a significant relationship 6.5% breastfed for 15, 18, and 24 months, respectively.
between the students’ knowledge and attitudes scores (r = Thirty-six percent had prelacteal feeds given to their babies.
0.236, P = .011). Eighty percent of the students reported that A weak negative correlation (–0.253) existed between giving
they got adequate breastfeeding knowledge and skills in their prelacteal feeds and duration of exclusive breastfeeding.
nursing program, and 70% were confident in their ability to Reasons for stopping continued breastfeeding included baby
provide breastfeeding support. old enough (49%), return to work (18.4%), and hungry baby
or teething and biting (16.3%).
Conclusion
Conclusion
Results revealed weak breastfeeding knowledge scores
among students and neutral breastfeeding attitudes. Breastfeeding practices of physician-mothers do not
Strategies to improve breastfeeding education in nursing conform to the World Health Organization standards. The
curriculum focusing on breastfeeding management skills impact of this on their clients need to be measured in further
are warranted. studies.
Breastfeeding Practices of Physician-Mothers Early Weight Loss in Breastfeeding Newborns
in Ife-Ijesa Zone, Osun State, South West, Nigeria
Carol Traa, MSN, RN, IBCLC,
Oluwaseun Taiwo Esan, MBchB, MPH, Florence Omekara, MSN, MHPM, RN,
and Bridget Omisore, MBBS Lori Irwin, BSN, MS, CNS,
Obafemi Awolowo University Teaching Hospitals, and Deborah Eldredge, PhD, RN
Ile-Ife, Ijesa, OsunState, Nigeria Oregon Health Sciences University,Portland, Oregon,
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4. ILCA 2011 Abstracts 79
Background Background
Early weight loss may reflect feeding problems leading to Exclusive breastfeeding has been proven to be a key tool for
breastfeeding discontinuance and loss of host protection and improving maternal and child health. Recent studies from
developmental outcomes benefits. Lactation consultation Nigeria (a developing country) show a declining rate of
and postdischarge follow-up are provided for newborns exclusive breastfeeding despite a high infant mortality rate.
experiencing above average weight loss (>7% in 48 hours).
Many patients return to a remote domicile without follow-up Aim
care at the authors’ hospital. They determined early (inpa-
tient) intervention would benefit establishment and continu- This study assessed the perceptions about breastfeeding and
ance and is needed to identify their population’s contributing infant feeding practices among nursing mothers in a poor
factors to early weight loss. resource community.
Aims Methods
Develop and implement early breastfeeding support based A cross-sectional study carried out in Ile-Ife, South Western
on identified factors leading to weight loss in the first 48 Nigeria. Three hundred eighty nursing mothers were inter-
hours of inpatient life. viewed using a pretested semistructured questionnaire. The
results were collated and analyzed using SPSS version 16.0.
Methods
Results
In this descriptive correlation study, data were abstracted ret-
rospectively from the charts of 200 mother-infant pairs. Many of the nursing mothers (60.7%) did not believe babies
Descriptive statistics were used to describe infant (sex, ges- should be put to breast immediately after delivery, and about
tational age, number of breastfeedings) and maternal charac- a third (31.9%) did not believe that breast milk only could be
teristics (gravity, parity, delivery mode, epidural use, hospital enough for a child less than 4 months. About a quarter
length of stay, or depression). Hierarchical multiple regres- (23.5%) were not practicing exclusive breastfeeding,
sion techniques determined contributions of infant and whereas 98% said they would not breastfeed their babies up
maternal characteristics to percentage of weight loss. to 2 years of age for various reasons like sex of the child,
nature of mothers’ job, and to enforce intake of adult food on
the baby. Level of education and marital status had signifi-
Results
cant effects on the practice of exclusive breastfeeding.
Babies born by cesarean section lost more weight than did those
delivered vaginally (6.7% vs 4.2%). There was no difference in Conclusion
weight loss by gender, epidural use, or maternal depression.
Twenty years after the “Innocenti declaration,” incorrect
beliefs about exclusive breastfeeding and poor infant feeding
Conclusions
practices are still predominant among nursing mothers in this
There may be differences in maternal or infant feeding behav- community.
ior related to mode of delivery. The expected differences due
to maternal depression were not found. Early intervention Experiences of Lactating Working Mothers at a
with breastfeeding mothers experiencing cesarean section is Private Tertiary Care Setting of Karachi, Pakistan
appropriate. Further study is needed to measure and analyze
feeding behaviors and determine how postsurgical recovery, Shela Akbar Ali Hirani, MScN, BScN,
including pain management, influences breastfeeding estab- and Rozina Karmaliani, PhD, MPH
lishment and maternal confidence to continue. Aga Khan University, School of Nursing,
Karachi, Pakistan
Exclusive Breastfeeding and Infant
Feeding Practices in a Resource Poor Community Background
Folakemi Olajumoke Olajide, MB, ChB, FWACP, Abim- Pakistan has the second-highest child mortality rates in South
bola Olaniyi Olajide, MB, ChB, FWACS, Asia, and in this region, gradual decline in breastfeeding
and Olusegun Temitope prevalence has been reported especially among urban and
Afolabi, MB, ChB, FMCPH, MPH working mothers. In Pakistan, very little attention has been
Obafemi Awolowo University, Ile-Ife, Nigeria paid towards offering workplace support to breastfeeding
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5. 80 Journal of Human Lactation 28(1)
working mothers. Review of published literature confirmed Aim
that previously no such research has been conducted to unveil
the experiences of lactating working mothers in Pakistan. To understand the effect of infant tongue-tie on women’s
breastfeeding experiences.
Aims
Methods
To describe experiences of lactating working mothers and to
gain insight about the facilitators of and barriers to breast- Phenomenology using semistructured interviews. The par-
feeding among these mothers, as well as to seek recommen- ticipants were 10 women whose infants were diagnosed with
dations from the lactating working mothers to improve their tongue-tie at their first breastfeeding clinic visits.
breastfeeding practices.
Results
Methods
Analysis revealed several themes describing the story of
The authors used a qualitative descriptive design; 9 full-time breastfeeding a tongue-tied infant: expectations; something
lactating working mothers who met the inclusion criteria is wrong; questioning, seeking advice, no real answers;
were selected via purposive sampling. Researchers collected symptoms and perseverance; approaching the wall—it’s all
data until they reached saturation. Study participants were too much; relief.
recruited from 9 subunits of a private tertiary care setting of
Karachi, Pakistan. A semistructured interview guide was Conclusions
used to collect data from the participants.
The findings describe mothers’ experiences as being a har-
rowing journey. Initially, they are excited, enthusiastic, and
Results
determined. When they begin to realize something is wrong,
Most study participants verbalized that it was challenging to they seek answers from various people but find no explana-
combine breastfeeding with employment. Analysis of data tions or solutions. Despite their distress, pain, and concern
indicated that along with workplace environmental support, for their children, they persevere. However, as their prob-
maternal characteristics and her family support were equally lems breastfeeding escalate, they become more despondent,
essential to enable lactating working mothers to continue to the point that they feel they have no choice but to give up.
breastfeeding with employment. The findings further Some mothers are relieved when tongue-tie is identified.
revealed that inadequate workplace support leads towards Breastfeeding support is provided, which in some cases
adverse outcomes for the breastfeeding working mothers and includes recommendation for tongue-tie separation. For
their babies. some women, their breastfeeding experience improves. For a
few mothers, there are anger and disappointment that tongue-
tie was not identified sooner as they have already ceased
Conclusion
breastfeeding. Further education of health professionals
This study suggests a need to extend workplace and social regarding tongue-tie problems is required. This will enhance
support for working mothers in Pakistan to promote their their ability to inform and refer mothers on the basis of cur-
breastfeeding practices. rent evidence, while supporting them with breastfeeding.
Experiences of Mothers Geospatial Mapping of Lactation
Breastfeeeding an Infant With Tongue-Tie Services in Maricopa County, Arizona, USA
Janet Elizabeth Edmunds, RN, CM, IBCLC, Amanda L. Watkins, MS, RD, IBCLC,
Paul Fulbrook, RN, BSc, PHD, and Joan E. Dodgson, PhD, MPH, RN
and Sandra Miles, RN, BNsg, MNsg Arizona State University, Phoenix, Arizona
Sinnamon Park, Australia
Background
Background
For many breastfeeding mothers, lactation services are
Australian initial exclusive breastfeeding rates (80%) fall at 6 essential for overcoming challenges. An often cited contrib-
months (14%). One factor linked to breastfeeding difficulties uting factor to the sharp decline in breastfeeding after hospi-
that contributes to early breastfeeding cessation is infant tal discharge is the lack of community lactation services.
tongue-tie. Research focused on lactation services has been specific to a
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6. ILCA 2011 Abstracts 81
single agency or single type of agency. A broader public feeding can transmit infection. Exclusivity, however, is
health perspective that targets a whole community is needed notoriously difficult to measure accurately, and cross-sec-
if resources are to be used effectively. tional data may be unreliable.
Aims Aim
To geographically describe breastfeeding duration in relation To compare “exclusivity rates” when collected by 2 different
to available lactation resources within Maricopa County, Ari- methods in the same infants at 4 months.
zona, the fourth largest county in the United States (popula-
tion, ~4 million). The specific aims were to (1) describe Methods
breastfeeding rates in Maricopa County and (2) geographi-
cally compare these rates with all available breastfeeding The authors collected feeding data on infants born at an
resources (hospitals, WIC clinics, private clinics, and peer inner-city Boston hospital between 2008 and 2010. They
support groups). recorded all feeds in week 1 and then collected feeding data
by regular phone calls to the mother for 4 months. At 4
months, they calculated 2 “exclusive breastfeeding rates”:
Methods
one based on cross-sectional data (a single answer gained
The design was population level, cross-sectional, and from maternal 24-hour recall at 4 months) and one based on
descriptive. All available resources (N = 66) were surveyed longitudinal data (all data collected since birth for each
(100% participation rate) between July 2009 and March infant).
2010. Existing breastfeeding rate data were triangulated and
geographically mapped using GIS software. Results
According to cross-sectional data, maternal 24-hour recall
Results
at 4 months, 13% (33/248) of 4-month-olds were exclu-
Geographic distributions were displayed in a series of maps sively breastfed. However, according to longitudinal data,
that highlighted the relationships between availability of ser- only 6% (16/248) of the same 4-month-olds were exclu-
vices and breastfeeding rates. Pockets of disparity occur in sively breastfed; as many (48%, 17/33) had received for-
breastfeeding rates and were demonstrated both demograph- mula at other data collection points in the past 4 months.
ically and geographically. True rates of exclusivity may be far lower, as the longitudi-
nal data did not record all feeds and probably missed other
non–breast milk feeds.
Conclusions
Although geographic distributions have been widely used in Conclusion
public health, this methodology has not been applied to
breastfeeding promotion activities. Geographic descriptions Exclusive breastfeeding rates may be significantly overre-
of breastfeeding services are a viable method for determin- ported in cross-sectional studies based on 24-hour recall,
ing where to target breastfeeding support and promotion leading to exaggerated rates of exclusivity. This has major
efforts and resources. implications for health-related outcomes, especially in
areas where exclusivity is paramount.
How Exclusive Is Exclusivity? Accuracy
of Cross-sectional and Longitudinal Data Introducing Solids: How Accurate:
Is Maternal Recall at 1 Year?
Magdalena Buczek,1 Julia Margaret Coit, BA,1
Xena Grossman, MS, RD,2 Julia Margaret Coit, BA,
Lori Feldman-Winter, MD, MPH,2 Magdalena Buczek, Xena Grossman, MS, RD,
and Anne Merewood, PhD, MPH, IBCLC2 Lori Feldman-Winter, MD, MPH,
1
Boston University and 2Boston Medical and Anne Merewood, PhD, MPH, IBCLC
Center, Division of General Pediatrics, Boston Medical Center, Division of General
Boston, Massachusetts Pediatrics, Boston, Massachusetts
Background Background
Exclusive breastfeeding maximizes health outcomes; in dis- The American Academy of Pediatrics recommends exclu-
eases like HIV, exclusivity is protective, whereas mixed sive breastfeeding for 6 months. Early introduction of solids
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7. 82 Journal of Human Lactation 28(1)
can interfere with breastfeeding and is associated with Aim
adverse health outcomes like obesity. Many studies use
maternal recall to identify the age when infants start solids. To examine whether higher maternal body mass index
(BMI), lack of childbirth support (no DOULA), and in-hos-
pital formula supplementation (FORMULA) predict shorter
Aim
full breastfeeding (full BF) after adjusting for breastfeeding
To determine accuracy of maternal recall regarding starting intentions.
solids, at 1-year postpartum.
Methods
Methods
Low-income, first-time mothers giving birth to a single-term
Between 2008 and 2010, the authors telephoned mothers infant were systematically enrolled in the maternity unit (N =
of infants enrolled in a cohort study monthly for 6 months 170) and followed up at 4 days, 6 weeks, and 6 months. When
and asked if they had given their babies any solids in the available, participants received childbirth support from a
past month. The first month a mother answered yes was doula (25%). Participants completed the Infant Feeding Inten-
considered the month solids were started. At 1 year, the tions Scale at 25 ± 15 hours postpartum. The authors recorded
authors asked the same mothers when their children were the number of formula feeds given to the newborn during the
first given solids. Percentage agreement and the kappa sta- hospital stay. They used proportional hazards regression to
tistic (κ) were used to measure agreement between examine the hazard of increasing BMI, no DOULA, and FOR-
responses. MULA on the hazard of stopping full BF (defined as date
started other milks >1/wk). They adjusted for maternal breast-
Results feeding intentions, ethnicity, education, and age.
The authors obtained data on 148 women. At 1 year, 8% Results
(12/148) accurately described the month they first gave sol-
ids; however, 90% (133/148) reported starting solids later Estimated median duration of full BF was 23 days. In the
than they were actually started (κ = 0.05) (for example, the adjusted model, the hazard of stopping full BF increased as
monthly records indicated solids were started at 2 months, but follows: 24% (P = .01) for every 5-unit increase in BMI (kg/
at 1 year, the mother recalled starting at 6 months). On aver- m2); 80% (P = .03) if no DOULA; and 14% (P = .0002) for
age, incorrect responders overestimated by 2.3 months (range, every FORMULA feed.
1-8 months); 15.5% (23/148) overestimated by 4 or more
months. Conclusions
Modifiable factors predicted full BF duration. The results
Conclusion
support multidimensional approaches to increasing breast-
At 1 year postpartum, only 8% of women accurately recalled feeding duration, including the consideration of the current
when they first started solids. Similar errors in breastfeeding maternal obesity epidemic (BMI), improving the childbirth
studies could compromise the validity of reported health out- experience (DOULA), and minimizing the use of in-hospital
comes, especially if women consistently report starting solids formula supplements (FORMULA).
later than they were actually started.
Monitoring Code Adherence:
Maternal, Childbirth, and Maternity Unit Accuracy of a National Website
Factors in Duration of Exclusive Breastfeeding
Gregory Makrigiorgos,1 Stephanie Santana,1
Among US Low-Income First-Time Mothers
Emily Sanchez,1 Radha Sadacharan, BA, MA,2
Laurie Anne Nommsen-Rivers, PhD, RD, IBCLC Alison Stuebe, MD, MSc,2
Cincinnati Children’s Hospital Medical Center, and Anne Merewood, PhD, MPH, IBCLC2
1
Cincinnati, Ohio Boston University and 2Boston Medical Center,
Division of General Pediatrics, Boston,
Massachusetts
Background
Maternal obesity and maternity care practices have been Background
shown to influence breastfeeding duration. It is not known
to what extent maternal infant feeding intentions confound Hospital distribution of formula sample packs to new moth-
these findings. ers violates the World Health Organization Code. A national
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8. ILCA 2011 Abstracts 83
US campaign, Ban the Bags, was launched in 2006 to encour- Background
age discontinuation of this practice. The Web site, www.ban-
thebags.org, lists US hospitals that self-report discontinua- Recent trends reveal a record-high C-section rate of 31.8% in
tion of sample pack distribution. Given the major resources the United States (Centers for Disease Control and Preven-
required to track national trends in discontinuation proac- tion, 2009). C-section is a risk for suboptimal infant breast-
tively, for example, through telephone surveys, a reliable feeding, but few studies explore the relationship of pain
self-reporting system would be a useful, cost-effective tool management to breastfeeding after C-section.
to monitor adherence to this part of the code.
Aims
Aim
To identify (1) the relationship of pain score after C-section with
To assess the accuracy of hospital self-report to www.ban- time to initiation and frequency of breastfeeding in the first 24
thebags.org. hours postpartum and (2) the odds of successful breastfeeding
adjusting for confounders.
Methods
Methods
Hospitals self-report compliance by completing an online
form; this information is verified by a research assistant A retrospective cohort design. The sample was all C-sections
before appearing on the Web site. In 2009, the authors per- 34+ weeks’ gestation during 2007 at a community hospital.
formed a separate, proactive telephone survey, calling all The final sample size was 621. Data were extracted from com-
birthing hospitals in 20 states to determine if they distrib- puterized medical and inpatient records. Successful breast-
uted sample packs. They compared the number of pack- feeding was 6+ feedings in the first 24 hours postpartum.
free hospitals identified in the telephone survey with that
on the Web site. Hospitals reporting to the Web site after Results
the authors completed the survey were not counted in the
study. More than one half of the sample breastfed (54.4%), with a
mean time of 4.2 hours to initiation of breastfeeding. Statisti-
cally significant negative correlations were found for mean
Results
total pain score with number of breastfeeding sessions (P =
The telephone survey determined that 28% (350/1242) of .023). Using logistic regression, women with mild pain had
hospitals were pack free; the Web site listed 76% (267/350) 2.4 times (P = .03), breastfeeding within 2 hours of birth had
of these hospitals. Reliability varied by state; in Oregon, and 3.5 times (P = .000), term infants had 3.2 times (P = .006), and
Rhode Island, for example, 100% of hospitals self-reported not receiving supplemental feeds had 6.9 times (P = .002) the
(range, 33%-100%). odds of successful breastfeeding in the first 24 hours.
Conclusion Conclusions
Hospital self-report to a national Web site captured 76% of Pain control after C-section is an important predictor of suc-
sample pack-free hospitals in 20 states. This can be usefully cessful breastfeeding in the first 24 hours. Anesthesia
extrapolated to all 50 states. With additional publicity, self- implemented increased use of more effective pain modali-
report could be an accurate national tool to monitor this aspect ties. Additional nursing support was provided in the postan-
of code compliance. esthesia care unit. Follow-up data revealed mean time to first
breastfeed of 2 hours.
Post C-section Pain and Breastfeeding
Success in the First 24 Hours Postpartum Results of a Survey to Assess the
Experiences of Women Who Induced Lactation
Anne B. Woods, PhD, MPH, CNM,
Joan Robertson, MA, BSN, RN, Lenore Goldfarb, PhD, IBCLC
Grace Bourke, BSN, RNC, Union Institute and University Doctoral Program,
Joyce Carroll, BSN, RNC, Montreal, Quebec, Canada
Barbara Crist, BSN, RN, IBCLC,
Jennifer Duff, RN, Shirley Kowalewski, BSN, RNC, Staci Background
Moore, RNC, Judy Zacharias, RNC,
Selena Thomas, MD, and Donovan Dietrich, MD There exists a paucity of published studies on women who
Franklin Square Hospital, Gettysburg, Pennsylvania breastfed infants to whom they did not give birth. The last
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9. 84 Journal of Human Lactation 28(1)
study to evaluate a population of mothers who induced lac- suburban pediatric practice with lactation services. Both
tation/relactated/adoptive breastfed took place more than 30 groups of infants were born in the same hospital. The first
years ago. group (n = 38) was followed in the hospital by pediatricians
who supplemented with formula at a rate of 10.25%. The
Aims second group (n = 39) was followed by neonatal hospitalists
who formula supplemented at 7% weight loss and thus sup-
The purpose of this research was to survey women who had plemented 44.74% of their infants. At the first outpatient
induced lactation recently. visit, the liberally supplemented group was at 94.2% of their
birth weight compared to 94.1% of birth weight in the other
Methods group. At 1 month, the liberally supplemented group reached
128.7% of birth weight compared to 131.5% of birth weight
Participants (N = 228) were asked to complete an Internet- in the other group. In examining impact of liberal supple-
based survey designed to elicit their experiences. A mixed- mentation, it was found that 72.7% of infants who were fed
method approach facilitated the collection of quantitative only breast milk in the hospital were still exclusively
and qualitative data. breastfeeding at 6 months compared to 18.8% of formula-
supplemented infants.
Results
Telehealth Services to Support
Participants were primarily white/Caucasian, well-educated, Breastfeeding Mothers: A Pilot Study
Christian, married, high-income mothers, aged 23 to 58
years, and located in North America. Successful participants Wilaiporn Rojjanasrirat, PhD, RNC, IBCLC,
who reported they produced the largest milk supplies had Karen Ann Wambach, PhD, RN, IBCLC,
larger breasts and tended to follow a process that involved and Eve-Lynn Nelson, PhD
domperidone, a suitable birth control pill, and pumping. Par- Graceland University School of Nursing, Olathe, Kansas
ticipants with history of 1 or more pregnancies did not tend
to produce larger peak milk supplies. Participants with his- Background
tory of 1 or more births before inducing lactation/relactation
tended to produce larger peak milk supplies. Participants Telehealth, the use of telecommunication technology to
reported a successful (71%) and satisfactory (71%) overall remotely monitor patients’ health status, is a promising strat-
experience, and given the opportunity 83% would repeat it. egy to provide continuing support for breastfeeding mothers
after hospital discharge. At present, the use of telehealth for
assessing and supporting breastfeeding in postpartum women
Conclusion
has not been adequately explored.
Although successful participants who produced the largest
breast milk supplies in the present study tended to follow a Aims
self-reported protocol or procedure that involved domperi-
done as 1 of the ingredients, it is not possible within this To determine the feasibility of using telehealth equipment for
study to establish if it is the key variable to explain such assessing and providing breastfeeding support in women’s
outcomes. Further study using a different methodological homes.
approach such as a randomized controlled trial is needed.
Methods
Supplementation of Breastfed A descriptive study was conducted with 13 mother-baby
Infants in the Early Neonatal Period dyads. Observational data, collected twice during the first 4
Laura Duke, CPNP, IBCLC postpartum weeks by telehealth and home visit interna-
Pediatric Associates of Richmond, Inc, tional board certified lactation consultants (IBCLC) using
Midlothian, Virginia the LATCH, were compared to calculate interrater reliabil-
ity. The quality of pictures, sound, and participants’ satisfac-
According to the Centers for Disease Control and Preven- tion with home telehealth and equipment use were analyzed
tion, up to 25% of breastfed infants receive formula supple- using descriptive statistics.
mentation in the first few days of life without adequate medi-
cal indication. New perinatal core measures released by the Results
Joint Commission advocate that no more than 10% of healthy
term and late preterm infants receive supplementation in the The telehealth IBCLC was able to observe infant latching/
early newborn period. This small retrospective study suckling, milk transfer, types of nipple, and mother/infant
reviewed records of 2 groups of infants followed by a large positioning using telehealth equipment. The percentage
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10. ILCA 2011 Abstracts 85
agreement of LATCH category scores between the tele- decreased protein consumption, decreased vitamin absorption,
health and home IBCLC ranged from 40% to 100%. Inter- and increased risk of iron deficiency. After identification of
rater reliability using Spearman correlation coefficients was increasing rates of pregnancy after bariatric surgery, the
.76 and .67 for the total LATCH scores during the first and authors found minimal resources available for their patients
second visits, respectively. Most participants reported high who wanted to breastfeed.
satisfaction with using telehealth in their homes.
Aims
Conclusions
To understand the lactation experience of the individual who
Providing early postpartum support for breastfeeding moth- has undergone bariatric surgery for the treatment of obesity.
ers and infants via telehealth was acceptable and feasible. The Understanding the lactation experience of postbariatric
reliability of the LATCH score needs further assessment in a women may provide evidence to assist in designing strate-
larger sample and more rigorous study design. Further gies to meet the needs of these women.
research for application of telehealth to lactation support ser-
vice is warranted. Methods
This was a qualitative study with a phenomenological
The Lived Experience of Lactation
approach. The research team selected Van Manen’s method
Following Bariatric Surgery
for this study due to the human science emphasis and practical
Pamela Ann Hendrix, BA, RN, IBCLC, implications of everyday life. Data were collected from 8
Susan Lynn Welke, RNC-MNN, BAHCS, women who met the inclusion criteria.
Kerry Sue Foligno, RN, BSN, CLC,
and Angelina Rodriguez, ARNP, MSN, CNM
Results
Memorial Hospital West Family Birthplace, Pembroke
Pines, Florida Five themes emerged: nutritional issues, emotional roller-
coaster, lacking specialty care, patient as “expert,” and seek-
Background ing support.
The purpose of this study was to understand the lactation Conclusions
experience of the individual who has undergone bariatric sur-
gery for the treatment of obesity. Memorial Hospital West The team noted implications leading to the need for further
Family Birthplace had 4916 live births from May 2007 to education prenatal and postnatal for nurses, physicians, lac-
April 2008. On initial assessment, 85% stated that they tation consultants/counselors, and other health care person-
planned to breastfeed. The literature suggests increasing nel, opening the door to more research possibilities and
numbers of bariatric surgeries are being performed yearly. changes in public policy to help promote better outcome for
Postbariatric surgery effects include marked caloric reduction, these women.
Answers
1. A 4. B 7. B 10. C 13. A
2. C 5. A 8. B 11. C 14. A
3. A 6. C 9. D 12. D 15. C
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