Breastfeeding

Program Lead: Professor Lisa Amir

Breastmilk is the ideal food for infants. It provides all the nutrition a baby needs. It helps to protect against many common childhood illnesses. It also benefits the mother for example, by preventing or reducing breast cancer. And it’s very convenient. But it is not always easy to do.

The Centre is interested in all aspects of breastfeeding. Our staff and students have conducted randomised trials, cohort studies, cross-sectional studies, audits and qualitative studies in this area. Our projects include clinically focused studies on nipple and breast pain and infection and the use of medicines for breastfeeding women, as well as interventions aiming to increase the maintenance of breastfeeding in communities with low rates. We have partnerships with the major Victorian maternity services, Maternal and Child Health services, and the Australian Breastfeeding Association, the main advocacy group in Australia. Professor Lisa Amir is the founder and Editor-in-Chief of the International Breastfeeding Journal [external link].

A survey to define breastfeeding

Developing a core outcome set for breastfeeding research

This Delphi study with international stakeholders aims to develop a core outcome set of key, agreed upon breastfeeding definitions to improve the consistency and uniformity of outcomes reported in trials and systematic reviews designed to support women to breastfeed. It involves three rounds of surveys.

Research team: Lisa Amir, Clare Barnett, Christine East; on behalf of the Generic protocol for Cochrane Breastfeeding Reviews Working Party

Interventions for supporting breastfeeding

Developing a generic protocol for systematic reviews of randomised controlled trials

Many outcomes are reported in randomised controlled trials that aim to improve breastfeeding. Consistent with best practice, we are preparing a generic protocol to inform a core outcome set for systematic reviews of such interventions. The working group includes eminent international experts and consumer engagement through the Australian Breastfeeding Association.

Research team: Christine East, Lisa Amir, Catherine Chamberlain; in collaboration with Leanne Jones, University of Liverpool; on behalf of the Generic protocol for Cochrane Breastfeeding Reviews Working Party

Peer support for breastfeeding (RUBY study)

Exploring if proactive mother-to-mother support by telephone helps to keeping up breastfeeding for six months or longer

The World Health Organization and Australian health authorities recommend to exclusively breastfeed for the first six months of a baby’s life, feeding no other fluids or solids. Although most women in Australia start to breastfeed their baby, they often give up after some time. Only 15% of babies are still exclusively breastfed when they are five months old. Breastfeeding as a new mother can be difficult. This study explored if proactive mother-to-mother support helps with keeping up breastfeeding for six months or longer.
The study was carried out between February 2013 and December 2015 in three hospitals in Melbourne. Over 1500 first-time mothers took part.

Research team: Della Forster, Lisa Amir, Helen McLachlan, Touran Shafiei, Rhonda Small, Fiona McLardie-Hore, Heather Grimes, Christine East; in collaboration with Anita Moorhead, Royal Women’s Hospital; Mary-Ann Davey, Monash University; Cindy-Lee Dennis, University of Toronto; Lisa Gold, Deakin University; Kate Mortensen and Susan Tawia, Australian Breastfeeding Association

The study received funding from The Felton Bequest, Australia and La Trobe University.

The study found that 75% of the women who received phone support were still breastfeeding their six months old baby. In contrast, only 69% of the women who received the usual care were still breastfeeding at six months. These results show that it would be of great benefit to new mothers and their babies, if such peer support for breastfeeding would be widely available.

The main outcomes paper [external link] was published in EClinicalMedicine in 2019. The study was featured in The Age newspaper in an article titled "Mum-to-mum phone support boosts breastfeeding: Study" (Miki Perkins, 6 March 2019) and also in an interview on ABC Radio with Jon Faine on March 6, 2019.

Find more details on the Ruby webpage

Breastfeeding in public

Understanding community attitudes and identifying design solutions to increase women’s comfort with breastfeeding in public

Breastfeeding is important for maternal and child health. This is the public health message. Mothers should feel free to breastfeed whenever and wherever they need to. Yet there are many deterrents to breastfeed in public.

This project explored design features and community attitudes to breastfeeding in public. We wanted to find out which of these invite and which deter breastfeeding in public.

We conducted interviews and focus groups with breastfeeding mothers in three local government areas in 2016. In 2018, we did our research at The Royal Women’s Hospital.

Research team: Lisa Amir, Stephanie Amir, Helene Johns; in collaboration with Julie Rudner, La Trobe University; Jenny Donovan, Inclusive Design; Miranda Buck, Australian Breastfeeding Association; Sinead Currie and Pat Hoddinott, University of Stirling

We received input from over 80 mothers who spoke five languages. Also health professionals and council planning staff participated in our research. Using these data, we have developed design guidelines. These guidelines outline how a range of everyday shared spaces could become breastfeeding-friendly. They also suggest optimal design characteristics for dedicated breastfeeding spaces.

This research was supported by a La Trobe Building Healthy Communities Research Focus Area grant.

An article about this study [external link] was published in The Conversation in June 2019.

Medicines and breastfeeding

Health providers and consumers are often unsure about the safety of medicines when a woman is breastfeeding. Fear of medicines is increasingly leading women to stop breastfeeding unnecessarily. Most medicines can be used safely during breastfeeding at the recommended dose, but there are exceptions that necessitate caution.

Medicine use for breastfeeding women is an ongoing research topic at the Judith Lumley Centre. Several research projects have been undertaken over time. Please refer to the Medicines and breastfeeding webpage for further details.

The role of micro-organisms in nipple and breast pain in breastfeeding women (CASTLE study)

Investigating the role of microorganisms S. aureus & C. albicans in the pathogenesis of breast pain and infection in lactating women

There is controversy about the condition known as ‘breast thrush’ or breast candidiasis in lactating women which has led to confusion among clinicians and the community. This is the first prospective longitudinal study to examine simultaneously both Staphylococcus aureus and Candida spp in breast infections and was designed to resolve the current controversy surrounding the primary organism responsible for the condition known as ‘breast thrush’: Candida spp or S aureus?

This project is a descriptive study of 360 breastfeeding women, recruited from the Royal Women’s Hospital and Frances Perry House. It also looked at maternal physical and mental health in the first eight weeks after giving birth.

Research team: Lisa Amir and Méabh Cullinane; in collaboration with Suzanne Garland and Sepehr Tabrizi, Bio21 Molecular Science & Biotechnology, University of Melbourne; Susan Donath, Murdoch Children’s Research Institute; Catherine Bennett, Deakin University

This research was supported by NHMRC Health Professional Research Fellowship 2006-2010 (LA); NHMRC Project Grant 2009-2010; NHMRC Equipment Grant 2009-2010; Helen Macpherson Smith grant 2011-2012.

The primary outcomes paper [external link] was published in BMJ Open in 2013. Key messages:

  • Candida spp is associated with burning nipple pain and breast pain.
  • Colonisation with S aureus is common; at least 50% of women were colonised with S aureus in nipple or milk samples by 4 weeks postpartum.

Nine papers have been published since and further publications are in preparation.

Find out more about this study on the CASTLE webpage

Supporting breastfeeding in local communities (SILC study)

Exploring if increased breastfeeding support early on improves breastfeeding maintenance

Breastfeeding provides infants with the optimal start to life. However, exclusive breastfeeding for six months is uncommon in Australia.

We had three groups in this study in ten Victorian Local Government Areas. Group 1 received standard care. The women in group 2 were given breastfeeding support at home. Group 3 not only had home visits but were also given access to community-based breastfeeding drop-in centres.

We found no difference in breastfeeding maintenance at three, four or six months in either the home visit or home visit plus drop-in groups compared with the comparison group. Early home-based and community-based support proved difficult to implement. Interventions to increase breastfeeding in complex community settings require sufficient time and partnership building for successful implementation.

Research teamHelen McLachlan, Della Forster, Lisa Amir , Rhonda Small, Méabh CullinaneTouran Shafiei, Lyn Watson, Rhian Cramer, Lael Ridgeway

The study received funding from the Victorian Department of Education and Early Childhood Development.

Find more information on the SILC webpage