Does infant carrier use increase breastfeeding exclusivity? A randomized controlled trial with low-income Latina mothers

• In Event: 1-048 - Keep on carrying on: Effects of carrying on infant nutrition, motor development, and social interaction

Integrative Statement

Introduction
Exclusive breastfeeding is internationally recognized as the optimal infant nutrition for the first six months of life (Kramer & Kakuma, 2009). Yet low-income families have a decreased likelihood of exclusive breastfeeding for the recommended six months (McLeod et al., 2002; Scott et al., 2001), which can exacerbate early socioeconomic disparities in infant health and development. Mother-infant skin-to-skin contact immediately after birth increases breastfeeding initiation, but virtually nothing is known regarding how physical contact (without direct skin-to-skin contact) in the first months postpartum impacts exclusive breastfeeding. We tested whether increasing mother-infant physical contact by providing mothers with infant carriers would increase breastfeeding exclusivity. We also examined several psychological and behavioral mechanisms through which mother-infant physical contact may contribute to maintenance of exclusive breastfeeding, including maternal perceptions of milk supply.

Hypotheses
We hypothesized that mother-infant physical contact facilitated by infant carrying would increase the likelihood of exclusive breastfeeding and the frequency of direct breastfeeding among mothers in the intervention group.

Study Population
One-hundred low-income, primarily Latina mothers participating in Project Concern International’s Healthy Start program were recruited during pregnancy and evaluated at two weeks postpartum.

Methods
Pregnant mothers were randomly assigned to receive an infant carrier and training on infant carrying to promote mother-infant physical contact (experimental group) or standard care (control group). At 30 weeks gestation, we measured maternal intention to exclusively breastfeed and past experience with breastfeeding. Breastfeeding exclusivity, frequency of direct (versus bottle) breastfeeding, and frequency of formula supplementation were measured at two weeks postpartum with an online questionnaire. We tested the psychological mechanisms underlying the relationship between physical contact and breastfeeding exclusivity, including perceived insufficient milk supply, breastfeeding confidence, and postpartum depression.

Results
Preliminary analyses with a subset of the data (N = 31 intervention, N = 22 controls) show that during pregnancy, there was no difference between groups in intention to exclusively breastfeed or past breastfeeding experience. At two weeks postpartum, mothers in the experimental group were more likely to be exclusively breastfeeding than mothers in the control group (p = .004). Mothers in the experimental group reported increased frequency of feeding breastmilk directly from the breast (p = .05) and decreased frequency of feeding infant formula (p = .006). Mothers in the experimental group were less likely to report issues with low milk supply than mothers in the control group (p = .03).

Discussion
Our results show that increased infant carrier use may increase breastfeeding success by decreasing perceptions of perceived insufficient milk, the most common reason for ending breastfeeding prematurely (Gatti, 2008). Providing mothers with infant carriers is a low-cost intervention that may reduce breastfeeding disparities in low-income families.

Authors

• Emily Elysia Little, Nurturely
  Presenting Author

• Lisa Bain, Project Concern International
  Non-Presenting Author

• Cristine H Legare, University of Texas at Austin
  Non-Presenting Author

• Jennifer Hahn-Holbrook, University of California, Merced
  Non-Presenting Author