2023 NANDA-I Conference

Interrupted Breastfeeding (00105): Scoping Review

Suellen Emidio, Simoní Bordignon, Elenice Valentim Carmona, Dorothy Jones

Dr. Suellen Emidio

Post-doc fellow- Marjory Gordon Program
Professor at the University of Juiz de Fora, Brazil
Introduction
• The nursing diagnosis of "Interrupted Breastfeeding" (00105) refers to a disruption or cessation of
breastfeeding before the desired or planned duration. Several factors can contribute to interrupted
breastfeeding:

Maternal choice or health issues Lack of breastfeeding support

Infant health issues Psychological factors

Maternal employment or separation Inadequate milk supply

Dietrich Leurer et al., 2019; Emidio et al., 2020; Duale et al., 2021
Introduction
Consequences for Mothers: Consequences for Infants:

• Emotional distress; • Nutritional impact;

• Impact on maternal bonding; • Increased risk of illness;

• Increased risk of postpartum • Disruption of feeding routine;

complications;
• Potential impact on long-term health.
• Hormonal changes.

Gianni et al., 2019; Kaur et al., 2020; Keim et al., 2020; Louis-Jacques; Stuebe, 2020
Introduction
Interrupted breastfeeding (00215)
Standardized nursing languages need to be revised and updated, to
adequately express what nurses identify in their clinical practice, based on
scientific
Domain 2 evidence, and describe with greater precision the phenomena related
Class 1
to breastfeeding.

Focus of the diagnosis:

It isbreastfeeding
an ongoing process, without an endpoint.
Level of Evidence 2.2
The refinement of breastfeeding-related diagnoses can improve documentation
and guide the delivery of more targeted Nursing interventions, which may
Definition: Breakto
contribute inincreased
the continuity of feeding
accuracy milk fromthe
in diagnosing theproblems
breasts, and achieving
which may compromise breastfeeding success and/or nutritional
breastfeeding levels recommended by the WHO, as a health indicator.
status of the infant/child.
Herdman; Kamitsuru, Lopes, 2021
Purpose
Identify support from literature for the elements of the nursing diagnose (ND)
"Interrupted breastfeeding" (00105) of NANDA-I.
Method
• Scoping review

• Five steps:

a) identification of the research question; The Joanna Briggs guidelines for scoping
reviews
b) identification of relevant studies;

c) selection of studies; Preferred Reporting Items for Systematic

Reviews and Meta-Analyses - PRISMA
d) data analysis;

e) synthesis and presentation of data.

Whittemore; Knafl, 2005; JBI, 2015; Page et al., 2021

 Method
November 2020 until January
2021
Quantitative, and qualitative
"What are the clinical indicators studies and systematic reviews
related to breastfeeding in mother- provide information about PubMed
infant dyads in the first six breastfeeding in infants until six CINAHL
months?” months.
BVS/BIREME
Web of Science
“What are the factors that affect Studies written in English,
SCOPUS
breastfeeding in mother-infant Portuguese, or Spanish.
dyads in the first six months?”
Newborn, Infant, Mother,
Without time limit.
Breastfeeding, Lactation, and
Weaning.
 Identification
Databases records identified Duplicate records removed
(n = 5267) (n = 1134)

Records screened Records excluded

(n = 4133) (n = 979)
Screening

Reports sought for retrieval

(n = 155 )

Reports excluded:
Reports assessed for eligibility Did not presenting the concept studied (n= 65)
(n = 89) Did not present the studied population (n= 28)
Did not found in full (n=1)
Included

Studies included in review

(n = 61)

Figure 1: Flowchart of the process of identification, selection, and inclusion of studies, based on PRISMA
recommendation. Campinas, Brazil, 2021.
Results
• 61 studies;

• 78.6% (n=48) of quantitative studies;

• 24.5% (n=15) studies with cross-sectional design and 1.6% (n=1) case-control;

• Almost all of the research was carried out with puerperal women;

• United States (32.7%);

• Maternal experience and self-efficacy are relevant factors related to continued breastfeeding.
Table 1: Proposal of elements included in the Nursing Diagnosis "Interrupted
breastfeeding", according to scoping review. Campinas, 2021.

Elements Proposal

Maternal pain
Defining
characteristics Mother does not want to breastfeed

Lack of knowledge about breastfeeding

Insufficient breast milk production

Lower self-efficacy of breastfeeding

Related factors Nipple injury

Mother obesity

Low Socioeconomic status

Primiparous women

Associated conditions Cesarean birth

Discussion
Changes to related factors

“Abrupt weaning of infant” to “Interruption of feeding milk by breasts”;

• It is frequent and common for mothers not to offer breast milk when they return to work outside the home, which
causes physical distancing from the baby;

• This process of interruption of lactation needs a careful assessment from nurses to identify the factors related to it
and, thus, propose strategies to maintain the supply of breast milk.

Kaur et al., 2020; Munn et al., 2018; Santacruz-Salas et al., 2019

Discussion
Proposal for new elements
• Maternal pain can result in the interruption of breastfeeding. In the first 14 days postpartum, the woman
may experience, in addition to the pain of the breastfeeding establishment process, gynecological pain related
to childbirth, muscle fatigue, and gastric discomforts.

• Nipple lesions present themselves as one of the main challenges to the establishment of breastfeeding. Nipple
injuries, superficial or deep, are common, being one of the major causes of weaning or decreased milk
production related to the absence of a baby or mechanical stimulation in the breast.

• Lack of knowledge about breastfeeding, its benefits, and challenges can be important reasons for stopping
breastfeeding and early weaning. The literature points out that education for lactation must occur since the
prenatal care for the pregnant woman and her partner and family, and the support network is a fundamental
partnership for the success of breastfeeding

ACOG, 2021; Amir & Bearzatto, 2016; Karaçam & Sağlık, 2018; Palmquist et al., 2020
Discussion
Proposal for new elements

• Mother's perception of self-efficacy, and whether her milk is sufficient for breastfeeding early in the
postpartum experience;
o Since nurses can spend more time with the mother, especially during the breastfeeding process, they need to focus on
these factors and identify strategies that will improve the results of the breastfeeding experience.

• Remove "Unsustained suckling at breast" because is clinically contemplated in "Ineffective latching on to

breast”.

Chang et al., 2020; DeVane-Johnson et al., 2017; Giannì et al., 2020; Peacock-Chambers et al., 2017
Implications for practice
• The modifications suggested by findings from this study will undergo further content and clinical

validation.

• The contents analyzed in this work will serve as the basis for the construction of operational definitions

that, after being validated, will be part of the instrument for collecting clinical data.

• Hopefully, this review will help nurses deepen the issues related to the assessment of breastfeeding in the

mother-baby dyad in the first six months of life.

References
• Dietrich Leurer, M., Petrucka, P., & Msafiri, M. (2019). Maternal perceptions of breastfeeding and infant nutrition among a select group of Maasai women. In BMC Pregnancy Childbirth, 19(1), 8-18. https://doi.org/ 10.1186/s12884-018-2165-7.

• Duale, A., Singh, P., & Al Khodor, S. (2021). Breast Milk: A Meal Worth Having. Front Nutr, 8, 800927. https://doi.org/10.3389/fnut.2021.800927

• Emidio, S. C. D., Moorhead, S., Oliveira, H. C., Herdman, T. H., Oliveira-Kumakura, A. R. d. S., & Carmona, E. V. (2020). Validation of Nursing Outcomes Related to Breastfeeding Establishment. International Journal of Nursing Knowledge, 31(2), 134-144.
https://doi.org/https://doi.org/10.1111/2047-3095.12256

• Gianni, M. L., Bettinelli, M. E., Manfra, P., Sorrentino, G., Bezze, E., Plevani, L., . . . Mosca, F. (2019). Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation. Nutrients, 11(10). doi: https://doi.org/10.3390/nu11102266.

• Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (2021). NANDA International, Inc. Nursing diagnoses: Definitions and classification, 2020–2023 (12th ed.). Thieme.

• Joanna Briggs Institute (JBI). (2015). Joanna Briggs Institute Reviewers’ Manual (2015 ed.). Adelaide:The Joanna Briggs Institute. Avaiable from: http://joannabriggs.org/assets/docs/sumari/ReviewersManual-2015.pdf

• Kaur, J., Sodhi, M. K., Mahajan, S., Singh, K., Kumar, A., Kaur, A., . . . Kapoor, R. (2020). Evaluation of utility of various interventions related to relactation and assessment of outcomes of relactation practice in mothers with infants up to 6 months of age. Perinatology, 21(3), 105-111.

• Keim, S. A., Jackson, J. L., Litteral, J. L., Schofield, K. A., & Crerand, C. E. (2020). Perceptions About Lactation Consultant Support, Breastfeeding Experiences and Postpartum Psychosocial Outcomes. Maternal and Child Health Journal, 25(3), 497-506. https://doi.org/
10.1007/s10995-020-03056-5

• Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., . . . Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj, 372, n71. https://doi.org/10.1136/bmj.n71

• Louis-Jacques, A. F., & Stuebe, A. M. (2020). Enabling Breastfeeding to Support Lifelong Health for Mother and Child. Obstetrics and Gynecology Clinics of North America, 47(3), 363-381. https://doi.org/10.1016/j.ogc.2020.04.001.

• Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. J Adv Nurs, 52(5), 546-553. https://doi.org/10.1111/j.1365-2648.2005.03621.x

• World Health Organization (WHO) (2017). Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services . Genebra: World Health Organization. Avaiable from: https://apps.who.int/iris/handle/10665/259386

• Feenstra, M. M., Jørgine Kirkeby, M., Thygesen, M., Danbjørg, D. B., & Kronborg, H. (2018). Early breastfeeding problems: A mixed method study of mothers' experiences. Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives , 16, 167-174.
https://doi.org/10.1016/j.srhc.2018.04.003.

• Chang, Y. S., Glaria, A. A., Davie, P., Beake, S., & Bick, D. (2020). Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review. Maternal & child nutrition, 16(1), e12865. https://doi.org/ 10.1111/mcn.12865

• DeVane-Johnson, S., Woods-Giscombé, C., Thoyre, S., Fogel, C., & Williams, R. (2017). Integrative Literature Review of Factors Related to Breastfeeding in African American Women: Evidence for a Potential Paradigm Shift. Journal of Human Lactation, 33(2), 435-447.
https://doi.org/10.1177/0890334417693209

• Feldman-Winter, L., Kellams, A., Peter-Wohl, S., Taylor, J. S., Lee, K. G., Terrell, M. J., . . . Stuebe, A. M. (2020). Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks. Pediatrics, 145(4). https://doi.org/10.1542/peds.2018-3696

• Huang, L., Xu, S., Chen, X., Li, Q., Lin, L., Zhang, Y., . . . Yang, N. (2020). Delayed Lactogenesis Is Associated with Suboptimal Breastfeeding Practices: A Prospective Cohort Study. The Journal of nutrition, 150(4), 894-900. https://doi.org/10.1093/jn/nxz311.

• Munn, A. C., Newman, S. D., Phillips, S. M., Mueller, M., & Taylor, S. N. (2018). Factors Influencing Southeastern U.S. Mothers' Participation in Baby-Friendly Practices: A Mixed-Methods Study. Journal of human lactation: official journal of International Lactation Consultant Association ,
34(4), 821-834. https://doi.org/10.1177/0890334417750143

• Peacock-Chambers, E., Dicks, K., Sarathy, L., Brown, A. A., & Boynton-Jarrett, R. (2017). Perceived Maternal Behavioral Control, Infant Behavior, and Milk Supply: A Qualitative Study. Journal of developmental and behavioral pediatrics, 38(6), 401-408.
https://doi.org/10.1097/DBP.0000000000000455

• Rodrigo, R., Rodrigo, A., Liyanage, N., Hatahagoda, W., & Hewavitharana, U. (2019). Maternal Perception of Adequacy of Mother’s Milk Among Mothers Giving Birth at a Teaching Hospital in Sri Lanka. Journal of Human Lactation, 35(1), 171-180.

• Palmquist, A. E. L., Holdren, S. M., & Fair, C. D. (2020). "It was all taken away": Lactation, embodiment, and resistance among mothers caring for their very-low-birth-weight infants in the neonatal intensive care unit. Social science & medicine (1982), 244, 112648.
https://doi.org/10.1016/j.socscimed.2019.112648

• Parker, L. A., Krueger, C., Sullivan, S., & Mueller, M. (2020). Demographic, Social, and Personal Factors Associated with Lactation Cessation by 6 Weeks in Mothers of Very Low Birth Weight Infants. Journal of Human Lactation, 37(3), 511-520. https://doi.org/10.1177/0890334420940239

• https://doi.org/10.1177/0890334418773304

• Zimmerman, E., Rodgers, R. F., O'Flynn, J., & Bourdeau, A. (2019). Weight-Related Concerns as Barriers to Exclusive Breastfeeding at 6 Months. Journal of human lactation: official journal of International Lactation Consultant Association , 35(2), 284-291.
https://doi.org/10.1177/0890334418797312
 Thank you!
suellen.emidio@outlook.com