IntroductionNational breastfeeding rates have improved in recent years, however, disparities exist by socioeconomic and psychosocial factors. Suboptimal breastfeeding overburdens the society by increasing healthcare costs. Existing breastfeeding supports including education and peer support have not been sufficient in sustaining breastfeeding rates especially among low-income women. The preliminary outcomes of contingent incentives for breastfeeding in addition to existing support show promising effects in sustaining breastfeeding among mothers in the Special Supplemental Nutrition Programme for women, infants and children (WIC).Methods and analysisThis trial uses a parallel randomised controlled trial. This trial is conducted at two sites in separate states in the USA. Mothers who were enrolled in WIC and initiated breastfeeding are eligible. Participants (n=168) are randomised into one of the two study groups: (1) standard care control (SC) group consisting of WIC breastfeeding services plus home-based individual support or (2) SC plus breastfeeding incentives (SC +BFI) contingent on demonstrating successful breastfeeding. All participants receive standard breastfeeding services from WIC, home-based individual support and assessments. Participants in SC receive financial compensation based on the number of completed monthly home visits, paid in a lump sum at the end of the 6-month intervention period. Participants in SC +BFI receive an escalating magnitude of financial incentives contingent on observed breastfeeding, paid monthly during the intervention period, as well as bonus incentives for selecting full breastfeeding food packages at WIC. The primary hypothesis is that monthly incentives contingent on breastfeeding in SC +BFI will significantly increase rates of any breastfeeding compared with SC. The primary outcome is the rate of any breastfeeding over 12 months. Randomisation is completed in an automated electronic system. Staff conducting home visits for support and assessments are blinded to study groups.Ethics and disseminationThe Advarra Institutional Review Board has approved the study protocol (Pro00033168). Findings will be disseminated to our participants, scientific communities, public health officials and any other interested community members.Trial registration numberNCT03964454

No abstract

INTRODUCTION: The benefits of breastfeeding for both a newborn and mother are well established. Parents often co-sleep with their children for ease of breastfeeding. However, co-sleeping is associated with sleep-related deaths. To alleviate this burden, Temple University Hospital (TUH) provided all newly delivered mothers with a Baby Box, a box with a firm mattress, for a safe sleeping environment. The purpose of this project was to study the impact of a safe sleeping environment on breastfeeding rates. METHODS: This is a retrospective study of patients between May 2016 and May 2018 who delivered at TUH and were provided a Baby Box prior to hospital discharge. A phone survey was performed after discharge. Categorical variables were analyzed using Pearson chi-squared test. This study on review by the TUH IRB was given exempt status. RESULTS: Of 4,394 eligible women, 26% reported exclusive breastfeeding of their infant. Approximately 26% of those exclusively breastfeeding reported using the Baby Box for infant sleep, and 54% reported that breastfeeding was easier while using the Baby Box. Approximately 32% of those who exclusively breastfed reported co-sleeping with their infant. There was no statistically significant difference between feeding method and use of the Baby Box. CONCLUSION: With the use of the baby box, the number of participants exclusively breastfeeding was low. Of those who exclusively breastfeed, there was a high rate of co-sleeping, despite being provided with a safe sleeping environment. This study demonstrates the need for continued efforts to promote breastfeeding and safe sleeping in this patient population.

Background Many women have low confidence in breastfeeding and have concerns regarding low milk volume or discomfort with breastfeeding. Antenatal hand expression may be an opportunity to help women feel more comfortable with breastfeeding and help promote exclusive breastfeeding. A study at a hospital in Philadelphia, Pennsylvania, U.S. assessed the feasibility of teaching antenatal hand expression at 39 weeks among socioeconomically disadvantaged populations, overall participant satisfaction and adoption of hand expression and breastfeeding. Methods From March 2020 to June 2021, women recruited at 34–39 weeks were taught to hand express, collect, and store colostrum. Starting from 39 weeks, participants were asked to practice hand expression 1–3 times / day until delivery, log their experiences, and store colostrum expressed. Women were contacted to encourage continued hand expression and answer any questions. Postpartum, a survey assessed satisfaction with hand expression and issues encountered. The survey also inquired about breastfeeding plans and barriers, and whether women were exclusively breastfeeding (defined as infants who received only breastmilk from the time of birth). Chart review of postpartum or well-baby visit notes determined whether women continued breastfeeding. Results Of the 29 participants, 72% (21/29) reported hand expressing at home, and no women reported contractions when hand expressing. Participants rated mean satisfaction of 8.1/10 (SD = 1.62) with antenatal hand expression, mean satisfaction of 9.4/10 (SD = 0.90) toward hand expression education, mean likelihood of 9.4/10 (SD = 1.24) recommending hand expression to others, and a mean score of 8.1/10 (SD = 1.69) on how helpful hand expression was in breastfeeding initiation. 90% (26/29) of women initiated breastfeeding after birth and 72% (21/29) exclusively breastfed on discharge, but only 11/29 (38%) continued exclusively breastfeeding when re-assessed 4–6 weeks postpartum. Barriers included maternal discomfort, low milk supply, and maternal or infant illness. Conclusions This study suggests that women in an urban setting would be willing to practice antenatal hand expression. A larger and adequately powered study could be feasible to determine associations between antenatal hand expression and breastfeeding rates and confidence.

BackgroundThe objective of this study is to assess whether antenatal hand expression at 39 gestational weeks helps increase patient confidence and skill with hand expression and increases initiation and exclusive breastfeeding rates.MethodsIn this IRB-approved study, patients were consented at 34-39 weeks gestation and taught by an IBCLC to hand express, collect, and store colostrum and record output. Starting at 39 weeks gestation, participants were asked to practice hand expression 1-3 times/day until delivery. A postpartum survey assessed patient satisfaction with hand expression and opinions on breastfeeding self-efficacy. Chart review of postpartum or well-baby visit notes determined whether patients continued exclusively breastfeeding.ResultsOf the 29 participants who delivered at Temple, 21/29 (72%) were exclusively breastfeeding on discharge, and only 11/29 (38%) reported exclusively breastfeeding at postpartum or well-baby visits. Barriers to the practice include maternal discomfort, low milk supply, and maternal and infant illness. Of the participants who completed the postpartum survey, 90% initiated breastfeeding and 72% reported hand expressing at home. They felt overall satisfied (8.1/10, ±1.62) with prenatal hand expression and stated that it was helpful in breastfeeding initiation (8.8/10, ±1.69).ConclusionsPrenatal hand expression starting as late as 39 gestational weeks still increased initiation and exclusive breastfeeding rates from 12% in the study period to 72% in the study group. Recognizing and addressing hand expression barriers during late pregnancy may help to further improve exclusive breastfeeding rates.