Abstract
“Ma ka Dudh Amrut,” this wonderful poem by Vijayanand Jamalpuri, captures the essence of this special issue on breastfeeding; it not only brings out the science behind breastfeeding but evokes the emotional side of this process that plays an important role in propagating the human race.
Human Milk banking is now an established perinatal service that impacts the quality of neonatal care and the outcome. Kulkarni et al. report on the “coming to volume” by redefining it as an expression of at least 80 mL volume in one sitting of the donation. Sayan Kumar Das et al. focused on the importance of HMB supplying adequate DHM, thus leading to reduced hospital stays and better NICU outcomes. Singh et al. have reported gaps in physicians’ and nurses’ knowledge of human milk banking and lactation aids, reinforcing the need to create adequate awareness at all healthcare system levels.
Quality improvement plays an important role in systematically improving healthcare systems and patient outcomes. A study from Bangladesh demonstrated the effectiveness of a QI initiative in augmenting the supply of mothers’ milk for preterm infants in a NICU setting, which led to a marked increase in milk expression rates and exclusive breastfeeding. Gadam et al. have reported a QI initiative that raised the first-hour breastfeeding rates from the baseline of 69%–88% in mothers who delivered vaginally. A similar initiative by Anil et al. in achieving universal early initiation of breastfeeding for vaginally delivered newborns in an Indian tertiary care hospital has shown sustained improvement in breastfeeding practices post-intervention.
Wilson et al.’s study on implementing antenatal breast milk care bundles versus postnatal care alone for preterm babies reveals significant improvements in milk availability and adequacy with antenatal counseling, while a study from Sri Ramchandra Institute of Higher Education & Research examined the impact of a reformed lactation support program on early initiation of breastfeeding, yielding significant improvements in both rates and timing across vaginal and cesarean deliveries. This underscores the importance of structured policies and interventions in fostering optimal breastfeeding practices, particularly in diverse clinical settings.
Mungala et al. have reported the use of breastfeeding assessment tools, that is, LATCH score, Bristol Breastfeeding Assessment tool, and Infant Breastfeeding assessment, and that each of the components of these tools was higher in the mothers who delivered vaginally compared to those who underwent LSCS. However, evidence on which assessment tool is useful to establish exclusive breastfeeding could have added strength to this study.
Mastitis in the postpartum period is known to affect exclusive breastfeeding. A study from Bangalore by Shadab et al. has reported Dynamic taping as a promising non-surgical treatment for lactational breast abscesses by showcasing its potential to facilitate resolution while allowing continued breastfeeding.
A personal experience from a pediatrician and a primi mother, Dr. Mandula Phani Priya, has emphasized the fact that knowledge, awareness, and verbal advice are often insufficient, and what mothers truly need is hands-on, practical support to master proper positioning and attachment. Are our healthcare workers skilled in providing this support is something we need to ponder on.
The positive effect of Breast crawl on the effectiveness of breastfeeding in the first 48 hours by Dhanawade et al. may be a way forward to include breast crawl as a routine practice in all setups, though this being a nonrandomized trial has the potential for selection bias and small sample limits the generalizability. A cohort study on the Effect of Breast Milk Feeding on Retinopathy of Prematurity in Neonates Less than 1800 Grams by Goyal et al. has highlighted an added benefit of breast milk feeding on reduction in ROP.
The case series on complex breastfeeding scenarios in a rural medical college by Asif et al. highlights different lactational challenges and explores different interventions in resource-limited rural settings.
Studies presented in this special issue offer insights into innovative approaches and interventions to improve breastfeeding practices and address lactational challenges in different contexts. Overall, they show how mothers, infants, and healthcare workers interact with breastfeeding determinants at the individual level, how these interactions drive breastfeeding outcomes, and what policies, support systems, interventions, and collaborations are needed for optimal breastfeeding.