The first two of the following 3 open-access studies examined breastfeeding duration. In the first study from Brazil, predictors of interruption of exclusive breastfeeding were the mothers' return to work or study shortly after the baby's birth and the use of a pacifier. The association of shorter duration of exclusive breastfeeding with the early return to paid work outside the home underscores the most basic and profound need for adequate paid maternity leave following an infant’s birth. In addition, the cognitive demands of task switching are also well-known -- of discerning and differentiating between things that are similar yet different re: switching back and forth between the breast and an artificial nipple. The cognitive demands of task switching have been and continue to be heavily studied in the cognitive sciences.
The second study comes from Germany, where researchers found that a high breastfeeding promotion index (BPI) via the World Health Organization's "Ten Steps to Successful Breastfeeding" was associated with higher odds of exclusive breastfeeding during the hospital stay and at discharge, while maternal factors for exclusive breastfeeding (breastfeeding experience and no early use of a pacifier) persisted beyond the hospital stay and date of discharge.
The third study below is from Iran, which compared the effects of two methods of sucking (on pacifier and mother's finger prior to gavage) on oral feeding behavior in preterm babies. Shortest hospitalizations in this preterm population were associated with sucking on the mother's finger.
Title: Determinants of the interruption of exclusive breastfeeding at the 30th day after birth.
In: Revista Paulista de Pediatria 2022; 40: e2021096.
Authors: Daniele Azevedo Kanan de Freitas, Thaymê Pires, Bruna dos Santos Willges, Letícia Daudt, Kimberli Dantas Käfer, Franciele da Silva Martins, Leandro Meirelles Nunes.
Abstract: "Objective: To estimate the prevalence of exclusive breastfeeding (EBF), introduction of water, herbal teas, or other milks, as well as to identify the factors associated with the interruption of EBF at the 30th day after birth. Methods: This is a cross-sectional study using structured and pretested questionnaires applied to 310 mothers in two moments: in person, at the maternity ward; and at the time the infant was 30 days of age, by telephone call. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables. Results: The maintenance of EBF at 30 days of age of the infant occurred in 85.2% of the sample, 1.6% receiving water, 11.5% herbal teas, and 8.2% other milk. Predictors for EBF interruption in the univariate analysis were the mothers' return to work or study activities shortly after the baby's birth (IR 2.88; 95%CI 1.14-7.25) and the use of a pacifier (IR 3.29; 95%CI 1.52-6.22). The interruption of EBF was lower in the group of participants who received support from the infant's maternal grandmother (IR 2.71; 95%CI 1.11-6.56) and their partner (IR 4.78; 95%CI 1.90-12.06). After a multivariate analysis, only the use of a pacifier (IR 5.47; 95%CI 2.38-19.3) and the partner's support (IR 6.87; 95%CI 2.04-23.1) maintained the association with the outcome.
Conclusions: The prevalence of EBF found in this study can be considered good, and future interventions aimed at increasing the duration of EBF in this population should take into account the participation of the partner and the reinforcement for not introducing the pacifier."
Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9190477/
Title: The role of breastfeeding promotion in German hospitals for exclusive breastfeeding duration.
In: Maternal & Child Nutrition 2022 Apr; 18(2): e13326.
Authors: Nele Hockamp, Erika Sievers, Philipp Hülk, Henrik Rudolf, Silvia Rudloff, Thomas Lücke, and Mathilde Kersting.
Abstract: "Breastfeeding promotion and support in hospitals is expected to have a positive impact on maternal breastfeeding outcomes. The objective of this study is to examine the association between breastfeeding promotion in maternity hospitals in Germany and exclusive breastfeeding (EBF) rates during the first 4 months. Thus, a nationwide cross‐sectional web‐based survey of breastfeeding promotion was conducted in 103 hospitals. Mother–infant pairs (n = 962) were recruited at these hospitals for a prospective web‐based survey of breastfeeding status at five‐time points, that is, during a hospital stay, at discharge as well as after 0.5, 2, and 4 months. The hospital analysis was based on the “10 Steps to Successful Breastfeeding” of the World Health Organization and the United Nations Children's Fund, adapted for Germany. Their degree of implementation was stratified by a breastfeeding promotion index (BPI) as low (≤5 steps), medium (6–8 steps), and high (≥9 steps). The association between the BPI and the odds of EBF at each of the five‐time points was estimated by multivariable regression models, adjusting for various maternal factors. At all time points, the proportion of EBF among mothers from high BPI hospitals exceeded the proportion of those from medium or low BPI hospitals. A high BPI was associated with higher odds of EBF during the hospital stay and at discharge, while maternal factors for EBF such as breastfeeding experience and no early use of a pacifier persisted beyond. The high commitment of hospitals and tailored support of mothers is essential for EBF."
Keywords: breastfeeding determinants, breastfeeding duration, breastfeeding promotion, exclusive breastfeeding, maternity hospitals, WHO/UNICEF ten steps
Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8932702/
From Iran:
Title: Comparison of the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants: a randomized clinical trial.
In: BMC 2022 May 18;22(1):292.
Authors: Fatemeh Shaki, Parvin Aziznejadroshan, Zahra Akbarian Rad, Mohammad Chehrazi, Afsaneh Arzani.
Abstract: "Background: Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants. Methods: This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother's finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother's finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used. Results: The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05). Conclusion: Considering the positive effect of these two methods, especially non-nutritive sucking on mother's finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit."
https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03352-9