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      Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation

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          Abstract

          Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt well-supported by health professionals. Maternal perception of not having a sufficient amount of milk, infant’s failure to thrive, mastitis, and the return to work were associated with a higher risk of non-exclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support.

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          Most cited references30

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          Reasons for earlier than desired cessation of breastfeeding.

          To describe the prevalence and factors associated with not meeting desired breastfeeding duration. Data were analyzed from 1177 mothers aged ≥18 years who responded to monthly surveys from pregnancy until their child was 1 year old. When breastfeeding stopped, mothers were asked whether they breastfed as long as they wanted (yes or no) and to rate the importance of 32 reasons for stopping on a 4-point Likert scale. Multiple logistic regressions were used to examine the association between the importance of each reason and the likelihood of mothers not meeting their desired breastfeeding duration. Approximately 60% of mothers who stopped breastfeeding did so earlier than desired. Early termination was positively associated with mothers' concerns regarding: (1) difficulties with lactation; (2) infant nutrition and weight; (3) illness or need to take medicine; and (4) the effort associated with pumping milk. Our findings indicate that the major reasons why mothers stop breastfeeding before they desire include concerns about maternal or child health (infant nutrition, maternal illness or the need for medicine, and infant illness) and processes associated with breastfeeding (lactation and milk-pumping problems). Continued professional support may be necessary to address these challenges and help mothers meet their desired breastfeeding duration.
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            Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year.

            Our goal was to determine why women stop breastfeeding at various times during their infant's first year. We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers approximately 2, 3, 4, 5, 6, 7, 9, 10 1/2, and 12 months after their child's birth, in which they were asked to rate the importance of 32 reasons for their decision to stop breastfeeding. We applied exploratory factorial analysis to extract meaningful constructs of mothers' responses to the 32 reasons. We then compared the percentages of mothers who indicated that each reason was important in their decision to stop breastfeeding among various weaning ages and used multiple logistic regression models to examine sociodemographic differences in the most frequently cited reasons for stopping breastfeeding. The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%-55.6%) and was even more frequent among Hispanic mothers and mothers with annual household incomes of or = 9 months of age. Our findings about the major reasons why mothers stop breastfeeding at various times during their child's first year should be useful to health professionals when attempting to help mothers overcome breastfeeding barriers and to health officials attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age.
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              Factors influencing the reasons why mothers stop breastfeeding.

              To explore the reasons why women stop breastfeeding completely before their infants are six months of age and to identify the factors associated with cessation and the timing of cessation.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                20 September 2019
                October 2019
                : 11
                : 10
                : 2266
                Affiliations
                [1 ]Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, via Commenda 12, 20122 Milan, Italy; priscilla.manfra@ 123456gmail.com (P.M.); gabriele.sorrentino@ 123456mangiagalli.it (G.S.); elena.bezze@ 123456policlinico.mi.it (E.B.); laura.plevani@ 123456mangiagalli.it (L.P.); giacomo.cavallaro@ 123456mangiagalli.it (G.C.); beatriceletizia.crippa@ 123456gmail.com (B.L.C.); lorenzo.colombo@ 123456policlinico.mi.it (L.C.); daniela.morniroli@ 123456gmail.com (D.M.); nadia.liotto@ 123456mangiagalli.it (N.L.); paola.roggero@ 123456unimi.it (P.R.); fabio.mosca@ 123456mangiagalli.it (F.M.)
                [2 ]Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; maria.bettinelli@ 123456unimi.it
                [3 ]Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), 6202 AZ Maastricht, The Netherlands; e.villamor@ 123456mumc.nl
                [4 ]Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; paola.marchisio@ 123456unimi.it
                [5 ]Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
                Author notes
                [* ]Correspondence: maria.gianni@ 123456unimi.it ; Tel.: +39-0255032483
                Author information
                https://orcid.org/0000-0003-3901-9131
                https://orcid.org/0000-0002-3317-5929
                https://orcid.org/0000-0003-2938-8953
                https://orcid.org/0000-0002-4921-1437
                https://orcid.org/0000-0001-9175-9394
                https://orcid.org/0000-0003-0425-5046
                https://orcid.org/0000-0003-1949-9123
                https://orcid.org/0000-0002-5691-3920
                Article
                nutrients-11-02266
                10.3390/nu11102266
                6835226
                31547061
                9e3c6232-d0dc-4b19-9150-fbe924eb2dc5
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 25 August 2019
                : 17 September 2019
                Categories
                Article

                Nutrition & Dietetics
                breastfeeding difficulties,early breastfeeding cessation,term infants,breastfeeding support

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