Browsing by Subject "breastfeeding"
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Item Breast Pumping in the Healthcare Workplace(2023-11-04) Yu, Corinna; Boyer, Tanna; Mitchell, SallyBackground: Reasons women do not breastfeed, or shorten their breastfeeding journey, include the lack of paid leave and the challenges of breast pumping in the healthcare workplace. Despite the health benefits of breastfeeding for mother and baby, health care workers returning to work often struggle to breast pump due to lack of access to lactation facilities and lack of time and support. The aim of this needs assessment was to determine the extent of these challenges. Methods: A survey was created and distributed through social media forums from 2020-2023 to determine the extent of these issues. IRB exemption was obtained (Protocol #2010273689). Responses were obtained from 222 health care workers across the United States. Data were analyzed and comments were sorted thematically. Results: Survey respondents were from the Midwest 30% (66), Southeast 25% (55), Northeast 18% (40), West 16% (35), and Southwest 10% (22) with 222 total responses. Physicians (n = 191) made up 86% of the responses across 11 specialties, with 15 of them being residents or fellows. There were 50% of respondents who did not have nearby access to a lactation room although 96% used a breast pump while at work. Pumping occurred every 2-3 hours for 48% and every 4-6 hours for 48% of respondents. Pumping duration was 11-20 minutes for 53% and 21-30 minutes for 32% of respondents, with transit time and other logistics taking an additional 1-5 minutes for 33%, 6-10 minutes for 47%, and 11-15 minutes for 12% of respondents. On a scale of 1-5, where 1 was “Pumping at work did not affect the duration of breastfeeding at all” and 5 was “I had to stop breastfeeding because I was not able to pump enough at work,” responses were 1 (19%), 2 (23%), 3 (20%), 4 (19%), 5 (19%). Respondents (n = 106; 48%) have used a wearable breast pump. On a scale from 1 to 10, where 1 is “No, I CAN NOT do my job equally well when wearing a breast pump” and 10 is “Yes, I CAN do my job equally well when wearing a breast pump,” 49% of those respondents chose 10. In the free text comments, multiple respondents discussed pumping while providing clinical care using wearable pumps. One person pumped while performing a vaginal delivery, another during an intraoperative code, and another while placing lines for a patient with a Type A aortic dissection. Discussion: Lack of access to lactation facilities, long transit times, frequent pumping, and long pumping sessions can be time prohibitive challenges for many health care workers. Lack of support from colleagues, administrators, and patients can influence breastfeeding duration. Wearable breast pumps have mixed reviews but have allowed many women to pump while doing normal work activities. Although only 107 respondents (48%) have used wearable breast pumps, 148 respondents (67%) answered “Does a wearable breast pump affect your ability to perform your job effectively?” suggesting opinions instead of personal experience. “Nearby access” of lactation facilities was not defined. The scope of work may differ from health care providers who do telemedicine, see patients in clinic, or perform codes in the operating room. Improvements on this survey include specifying the states for each US region and clarifying the year when respondents were breast pumping, as culture has evolved with a greater emphasis on wellness and increased numbers of women physicians. Expanding data on trainees would identify issues related to autonomy and educational practices. Conclusion: Accessible lactation rooms are lacking in the healthcare workplace. On average, respondents pumped every 2-6 hours with the majority taking 11-30 mins with 1-15 mins for logistics. Wearable breast pumps may be a viable option for some women to continue work activities while pumping. Workplace bias against breast pumping is still prevalent and more work needs to be done to support breast pumping women.Item Delayed Lactogenesis II is Associated With Lower Sleep Efficiency and Greater Variation in Nightly Sleep Duration in the Third Trimester(Sage, 2019-06) Casey, Theresa; Sun, Hui; Burgess, Helen J.; Crodian, Jennifer; Dowden, Shelley; Cummings, Shelby; Plaut, Karen; Haas, David; Zhang, Lingsong; Ahmed, Azza; Obstetrics and Gynecology, School of MedicineBackground: Metabolic and hormonal disturbances are associated with sleep disturbances and delayed onset of lactogenesis II. Research aims: The aim of this study was to measure sleep using wrist actigraphy during gestation weeks 22 and 32 to determine if sleep characteristics were associated with blood glucose, body mass index, gestational related disease, delayed onset of lactogenesis II, or work schedule. Methods: Demographic data were collected at study intake from primiparous women who wore a wrist actigraph during gestation weeks 22 (n = 50) and 32 (n = 44). Start and end sleep time, total nighttime sleep, sleep efficiency, wake after sleep onset, and sleep fragmentation were measured. Night to night variability was assessed with the root mean square of successive difference. Blood glucose levels, body mass index, and gestational disease data were abstracted from medical charts. Timing of lactogenesis II was determined by survey. Results: Between gestation week 22 and 32, sleep efficiency decreased and fragmentation increased (p < .05). During gestation week 32, blood glucose was negatively correlated with sleep duration, and positively related to fragmentation (p < .05). Women who experienced delayed lactogenesis II had lower sleep efficiency and greater fragmentation (p < .05), and greater night-to-night variability in sleep start and end time, efficiency, and duration during gestation week 32 (p < .05). Conclusion: Women with better sleep efficiency and more stable nightly sleep time are less likely to experience delayed onset of lactogenesis II. Interventions to improve sleep may improve maternal health and breastfeeding adequacy.Item Design of the Association of Uterine Perforation and Expulsion of Intrauterine Device study: a multisite retrospective cohort study(Elsevier, 2021) Anthony, Mary S.; Reed, Susan D.; Armstrong, Mary Anne; Getahun, Darios; Gatz, Jennifer L.; Saltus, Catherine W.; Zhou, Xiaolei; Schoendorf, Juliane; Postlethwaite, Debbie A.; Raine-Bennett, Tina; Fassett, Michael J.; Peipert, Jeffrey F.; Ritchey, Mary E.; Ichikawa, Laura E.; Lynen, Richard; Alabaster, Amy L.; Merchant, Maqdooda; Chiu, Vicki Y.; Shi, Jiaxiao M.; Xie, Fagen; Hui, Siu L.; Wang, Jinyi; Hunter, Shannon; Bartsch, Jennifer; Frenz, Ann-Kathrin; Chillemi, Giulia; Im, Theresa M.; Takhar, Harpreet S.; Asiimwe, Alex; Obstetrics and Gynecology, School of MedicineBackground Intrauterine devices are effective and safe, long-acting reversible contraceptives, but the risk of uterine perforation occurs with an estimated incidence of 1 to 2 per 1000 insertions. The European Active Surveillance Study for Intrauterine Devices, a European prospective observational study that enrolled 61,448 participants (2006–2012), found that women breastfeeding at the time of device insertion or with the device inserted at ≤36 weeks after delivery had a higher risk of uterine perforation. The Association of Uterine Perforation and Expulsion of Intrauterine Device (APEX-IUD) study was a Food and Drug Administration–mandated study designed to reflect current United States clinical practice. The aims of the APEX-IUD study were to evaluate the risk of intrauterine device–related uterine perforation and device expulsion among women who were breastfeeding or within 12 months after delivery at insertion. Objective We aimed to describe the APEX-IUD study design, methodology, and analytical plan and present population characteristics, size of risk factor groups, and duration of follow-up. Study Design APEX-IUD study was a retrospective cohort study conducted in 4 organizations with access to electronic health records: Kaiser Permanente Northern California, Kaiser Permanente Southern California, Kaiser Permanente Washington, and Regenstrief Institute in Indiana. Variables were identified through structured data (eg, diagnostic, procedural, medication codes) and unstructured data (eg, clinical notes) via natural language processing. Outcomes include uterine perforation and device expulsion; potential risk factors were breastfeeding at insertion, postpartum timing of insertion, device type, and menorrhagia diagnosis in the year before insertion. Covariates include demographic characteristics, clinical characteristics, and procedure-related variables, such as difficult insertion. The first potential date of inclusion for eligible women varies by research site (from January 1, 2001 to January 1, 2010). Follow-up begins at insertion and ends at first occurrence of an outcome of interest, a censoring event (device removal or reinsertion, pregnancy, hysterectomy, sterilization, device expiration, death, disenrollment, last clinical encounter), or end of the study period (June 30, 2018). Comparisons of levels of exposure variables were made using Cox regression models with confounding adjusted by propensity score weighting using overlap weights. Results The study population includes 326,658 women with at least 1 device insertion during the study period (Kaiser Permanente Northern California, 161,442; Kaiser Permanente Southern California, 123,214; Kaiser Permanente Washington, 20,526; Regenstrief Institute, 21,476). The median duration of continuous enrollment was 90 (site medians 74–177) months. The mean age was 32 years, and the population was racially and ethnically diverse across the 4 sites. The mean body mass index was 28.5 kg/m2, and of the women included in the study, 10.0% had menorrhagia ≤12 months before insertion, 5.3% had uterine fibroids, and 10% were recent smokers; furthermore, among these women, 79.4% had levonorgestrel-releasing devices, and 19.5% had copper devices. Across sites, 97,824 women had an intrauterine device insertion at ≤52 weeks after delivery, of which 94,817 women (97%) had breastfeeding status at insertion determined; in addition, 228,834 women had intrauterine device insertion at >52 weeks after delivery or no evidence of a delivery in their health record. Conclusion Combining retrospective data from multiple sites allowed for a large and diverse study population. Collaboration with clinicians in the study design and validation of outcomes ensured that the APEX-IUD study results reflect current United States clinical practice. Results from this study will provide valuable information based on real-world evidence about risk factors for intrauterine devices perforation and expulsion for clinicians.Item Impact of Perinatal Mood & Anxiety Disorder Education for Mothers in IU Health Arnett Breastfeeding Support Group(2019-04-03) Collins, Angela J.; Rawat, Meghana; Straut, AshleyBACKGROUND & OBJECTIVE: During the perinatal period, beginning at conception at lasting until the baby is 1 year old, mothers are at increased risk of mood and anxiety disorders. Baby Blues are common feelings of sadness/loneliness, which typically go away within 2 weeks postpartum. However, 20-25% of women experience more significant mood changes and symptoms than typical baby blues. Perinatal Moods and Anxiety Disorder (PMAD) is defined as prolonged symptoms from pregnancy to 1 year post-childbirth. Postpartum Depression (PPD) is the most common PMAD; 1 in 7 women are diagnosed with PPD in the US, with 600,000 per year. Unfortunately, Indiana-specific data on PMAD/PPD is not readily available. The objective of our PMAD/PPD Education and Awareness Intervention was to increase postpartum mental health care provided to the mothers who deliver at IU Health Arnett by 1) informing and educating mothers about symptoms and prevalence of PMAD and PPD, and 2) empowering women to seek treatment and support at the new IU Health Postpartum Support Group. METHODS: First, additional questions were added to the Edinburgh postnatal depression scale survey administered at IU Health Arnett to more effectively screen for PMAD/PPD. Second, we wrote text and phone call follow-up scripts for staff to contact mothers 4-5 months post-delivery to follow-up for possible symptoms of PMAD/PPD. Finally, we developed a 20-minute PMAD/PPD Awareness and Education presentation based on the Health Belief Model and presented it to the breastfeeding support group. During the presentation, we utilized voluntary pre- and post-surveys which collected data on knowledge of symptoms of PMAD/PPD. The data was then analyzed to evaluate the effectiveness of presentation. RESULTS: Data collection regarding efficacy of the Edinburgh postnatal depression scale survey changes and text and phone call follow-up scripts are still ongoing. The PMAD/PPD awareness and education presentation resulted in a 75% increase in knowledge of PMAD/PPD symptoms. Over 70% felt support groups would help with PMAD/PPD, 86% reported awareness of resources available to address PMAD/PPD symptoms in comparison to 50% in pre-survey, and 57% of mothers indicated they are confident to seek help for friends and themselves for PMAD/PPD CONCLUSIONS & IMPLICATIONS: Our findings indicate that the presentation was effective due to a significant increase in participant's knowledge of PMAD/PPD symptoms and significant increase in participant's awareness of PMAD/PPD resources. We expect that our changes will continue to increase postpartum mental health care provided to the mothers who deliver at IU Health Arnett. It is essential to standardize maternal follow-up care for PMAD and/or PPD for up to a year post-delivery. We must aid mothers in the community to learn about PMAD/PPD symptoms, use education to empower women to better advocate for themselves, help more women attend support groups for PMAD/PPD, help women's healthcare providers understand the need for education on PMAD/PPD, and advocate for inclusive postnatal exams for PMAD/PPD to become the standard of care.Item Should COVID-19 Mother Breastfeed her Newborn Child? A Literature Review on the Safety of Breastfeeding for Pregnant Women with COVID-19(Springer, 2021) Bhatt, Harshil; Medicine, School of MedicinePurpose of Review Breastfeeding is beneficial to both the newborn and the mother. During the COVID-19 pandemic, concerns have been raised on whether the SARS-CoV-2 virus could be transmitted from COVID-19 positive mother to the newborn through breastmilk. The purpose of this review is to examine the available evidence on the risks of transmission of infection from COVID-19 mothers to their newborns through breastfeeding. Recent Findings Data is very limited in this regard, with only a few smaller case series, and case reports have been published so far. In most of the studies, breastmilk samples from COVID-19 mothers tested negative for the virus. In the case reports where the virus was detected in breastmilk and the infants were diagnosed with COVID-19, it remained unclear whether the disease was transmitted through breastmilk or direct contact or through delivery. Another hypothesis is that the viral antibodies could pass to the newborn passively through breastmilk of COVID-19 positive mothers and give immunity to the child, but data is minimal. Summary Based on the currently available limited evidence and recognizing the benefits of breastfeeding, it may be concluded that if the health of the mother and her newborn allows, direct breastfeeding or extracted breastmilk should be encouraged by the healthcare providers after a careful discussion of the risks of vertical transmission to the mother and her family. Preventive measures should be taken by COVID-19 mothers to prevent droplet transmission of infection to the infants while breastfeeding.