Obstetrics and Gynaecology - Research Publications
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ItemRandom amplified polymorphic DNA analysis reveals no clear link between Staphylococcus epidermidis and acute mastitis(WILEY, 2022-08)Mastitis is commonly experienced by breastfeeding women. While Staphylococcus aureus is usually implicated in infectious mastitis, coagulase-negative staphylococci (CoNS) are a possible alternative pathogen. This case-control study examined the role of CoNS in mastitis using isolates cultured from breast milk of 20 women with mastitis and 16 women without mastitis. Gene sequencing determined bacterial species, and random amplified polymorphic DNA (RAPD) analysis investigated strain-level variation. The majority of CoNS isolates were Staphylococcus epidermidis (182/199; 91%). RAPD analysis identified 33 unique S. epidermidis profiles, with no specific profile associated with mastitis cases.
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ItemUsing domperidone to increase breast milk supply: A clinical practice survey of australian neonatal units(Wiley, 2017-12-01)Abstract Background Domperidone may be used off‐label to increase breastmilk supply. In the absence of manufacturer dosage recommendations, there is a need to compare the clinical practice guidelines used in Australian hospitals. Aim To compare existing clinical practice guidelines regarding the use of domperidone for increasing maternal breastmilk supply within Australian neonatal units (NNUs). Methods An electronic survey was distributed from April to July 2015 to relevant staff at each Level III NNU across Australia. Results Responses were received from 16 of 22 (73%) NNUs. All 16 (100%) NNUs considered domperidone their first line pharmacological agent of choice in the management of low milk supply, with 12 (75%) having a clinical guideline. Of the NNUs with a guideline, 11 (92%) recommended a standard maintenance dose of 10 mg three times daily (TDS). Duration of treatment was specified in 10 (83%) guidelines. Seven of 10 (70%) recommend a minimum duration of at least 2 weeks treatment before evaluating a response. Three of 11 (27%) guidelines that recommended 10 mg TDS permitted an increase to 20 mg TDS depending on response. Ten of 12 (83%) guidelines were modified in the previous 2–3 years, with eight revising their maximum dose to 30 mg/day, one limiting treatment duration to 7 days, and one removing the authority of NNU doctors to prescribe domperidone. Conclusion While all Australian neonatal units consider domperidone first‐line for pharmacological management of low milk supply, variability across clinical guidelines may suggest a lack of reliable evidence or awareness of evidence on which to base practice.
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ItemThe enablers and barriers to continue breast milk feeding in women returning to work(WILEY, 2016-04)AIM: To describe the enablers and barriers working women experience in continuing breast milk feeding after they return to work postpartum in urban Malaysia. BACKGROUND: In Malaysia, urban working women have low rates of breastfeeding and struggle to achieve the recommended 6 months exclusive breastfeeding. DESIGN: A qualitative enquiry based on a phenomenological framework and multiple methods were used to explore women's experiences in depth. METHODS: Multiple qualitative methods using face-to-face interview and participant diary were used. Data collection took place in urban suburbs around Penang and Klang Valley, Malaysia from March-September 2011. Participants were 40 employed women with infants less than 24 months. FINDINGS: Only 11 of the participants worked from home. Based on the women's experiences, we categorized them into three groups: 'Passionate' women with a strong determination and exclusively breastfed for 6 months, 'Ambivalent' women who initiated breastfeeding, but were unable to sustain exclusive breastfeeding after returning to work and 'Equivalent' women who introduced infant formula prior to returning to work. CONCLUSION: Passion and to a lesser extent intention, influenced women's choice. Women's characteristics played a greater role in their infant feeding outcomes than their work environment.
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ItemPolicy on infant formula industry funding, support or sponsorship of articles submitted for publication.(Springer Science and Business Media LLC, 2007-03-06)Despite current scientific evidence that artificial feeding is a harmful practice, unquestioned acceptance of breastfeeding as the normal or "default" method of infant feeding remains elusive in the industrialised world. Throughout the developing world the profound consequences of the aggressive marketing strategies of the infant formula industry since the end of the Second World War is well known. A key objective of the International Breastfeeding Journal is to promote breastfeeding through addressing issues that encourage breastfeeding initiation, duration and effective management. Informing this aim is the recognition of artificial feeding as a harmful practice that places infant health at risk. From this perspective it would be unethical for this journal to accept for publication any manuscript that has received funding, sponsorship or any other means of support from infant formula manufacturers. This stance is consistent with the journal's aim of supporting, protecting and promoting breastfeeding. It will also contribute to the promotion of a breastfeeding culture.
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ItemInfant feeding, poverty and human development.(Springer Science and Business Media LLC, 2007-10-22)The relationship between poverty and human development touches on a central aim of the International Breastfeeding Journal's editorial policy which is to support and protect the health and wellbeing of all infants through the promotion of breastfeeding. It is proposed that exclusive breastfeeding for 6 months, followed by continued breastfeeding to 12 months, could prevent 1,301,000 deaths or 13% of all child deaths under 5 years in a hypothetical year. Although there is a conventional wisdom that poverty 'protects' breastfeeding in developing countries, poverty actually threatens breastfeeding, both directly and indirectly. In the light of increasingly aggressive marketing behaviour of the infant formula manufacturers and the need to protect the breastfeeding rights of working women, urgent action is required to ensure the principles and aim of the International Code of Breastmilk Substitutes, and subsequent relevant resolutions of the World Health Assembly, are implemented. If global disparities in infant health and development are to be significantly reduced, gender inequities associated with reduced access to education and inadequate nutrition for girls need to be addressed. Improving women's physical and mental health will lead to better developmental outcomes for their children.
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ItemAvoiding risk at what cost? Putting use of medicines for breastfeeding women into perspective.(Springer Science and Business Media LLC, 2012-10-17)Breastfeeding women often need to take medicines, and therefore health professionals need to consider the effects of medication on lactation and the breastfed infant, and any associated risks. This commentary discusses the tragic case of a young woman with a history of mental illness who committed suicide in the postpartum period. She was determined to be a 'good mother' and breastfeed, and to avoid any potential adverse effects of medication on her breastfed infant. The final outcome was fatal for both mother and child. We argue that if women require medication during lactation, all risks need to be considered - the risk of not treating the maternal medical condition may greatly outweigh the potential risk to the breastfed infant.
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ItemBreastfeeding in public: "You can do it?".(Springer Science and Business Media LLC, 2014)On a regular basis there is an outcry about a mother who has been told to cover up or move away from a public area while she is breastfeeding. Mothers should feel free to breastfeed whenever they need to. However, the increasing market for "nursing covers" to hide the breast while feeding is evidence of changing perceptions. Discomfort with the idea of breastfeeding in public has been cited as a reason for some women choosing not to initiate breastfeeding or planning a shorter duration of breastfeeding. Other women are choosing to express and bottle-feed their expressed milk when they are in public. In many cultures today there is a conflict between the concept of breast milk being pure (like tears), and contaminated or "dirty" (like genital secretions or vomit). In these settings the female breast may be considered primarily a sexual organ, and therefore a private part of the body, which needs to be invisible in the public arena. In order to increase breastfeeding initiation and duration and to reduce health inequities breastfeeding needs to be more visible. Let's strive together to make breastfeeding in public unremarkable.
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ItemHealth professionals' advice for breastfeeding problems: not good enough!(Springer Science and Business Media LLC, 2008-09-11)Jane Scott and colleagues have recently published a paper in the International Breastfeeding Journal showing that health professionals are still giving harmful advice to women with mastitis. We see the management of mastitis as an illustration of health professionals' management of wider breastfeeding issues. If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis? There is an urgent need for more clinical research into breastfeeding problems and to improve the education of health professionals to enable them to promote breastfeeding and support breastfeeding women.
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ItemSocial theory and infant feeding.(Springer Science and Business Media LLC, 2011-06-15)Clinicians, public health advisors, nutritionists and others have been attempting to increase breastfeeding rates for the last few decades, with varying degrees of success. We need social science researchers to help us understand the role of infant feeding in the family. Some researchers in the area of food and nutrition have found Pierre Bourdieu's theoretical framework helpful. In this editorial, I introduce some of Bourdieu's ideas and suggest researchers interested in infant feeding should consider testing these theories.
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ItemThe CROWN Initiative: journal editors invite researchers to develop core outcomes in women's health(BIOMED CENTRAL LTD, 2014)Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a "core outcomes set" - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women's health have come together to support The CROWN (CoRe Outcomes in WomeN's health) Initiative.