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Biomedical subjects

M H Labbok

Publications and source records attributed to M H Labbok.

At least 19 recordsLinked to original sources
PubMed2001

Effects of breastfeeding on the mother.

In the rush to find nutrient alternatives to breastfeeding, a theme that dominated research on infant feeding throughout the twentieth century, only recently have new findings that reconfirm the importance of breastfeeding for maternal and child health begun to influence medical texts and health policy. Approximately 30 years of increasingly rigorous and positive research findings have led to the rediscovery of breastfeeding as a valid and evidence-based health intervention for infants. Unfortunately, because much of the research was designed to assess human milk as a nutrient replacement for infant formula, the literature on the effects of breastfeeding on maternal health remain limited. Nonetheless, a clear pattern of positive physiologic changes that lead to improved short-term and long-term health sequelae are emerging. All patients and their families should be informed fully as to the positive preventive health effects of breastfeeding not only for infants but also for mothers. Women have many difficult choices to make; it behooves physicians to ensure that they receive all of the facts on which to base these decisions.

Adult↗
PubMed2000

The efficacy of the lactational amenorrhea method (LAM) among working women.

The purpose of this study was to assess the efficacy of the lactational amenorrhea method (LAM) for family planning among mothers who are separated from their infants by work. The study population, 170 urban middle class women who planned to return to work before 120 days postpartum, were interviewed monthly for 6 months postpartum and contacted at 12 months. The study population received clinical support for expressing their milk and exclusively breast-milk feeding the infants and for the use of LAM for birth spacing. The cumulative life table pregnancy rate by 6-month was 5.2%, with 3 pregnancies, one at each of months 4, 5, and 6. LAM for working women, as described in this article, might be associated with a higher pregnancy risk than LAM use among non-working women. Therefore, women using LAM should be informed that separation from the infant might increase their risk of pregnancy.

Adult↗
PubMed2000

Multicenter study of the lactational amenorrhea method (LAM) III: effectiveness, duration, and satisfaction with reduced client-provider contact.

The objective of this effort was to assess the use and efficacy of the Lactational Amenorrhea Method (LAM) with reduced numbers of client-provider contacts. A co-sponsored multicenter study of LAM was performed to test the efficacy and acceptability of the method under "post-marketing" conditions, with investigator-initiated contact occurring only twice: at the time of intake and then again at month 7 of postpartum. These data are assumed to provide an assessment of LAM's use, efficacy, and performance that more closely reflects the prevailing conditions of these populations during normal use. Three hundred and sixty-two subjects were recruited through centers that had participated in the previous, more contact-intensive studies. Using a cooperatively developed protocol, data were gathered prospectively on at least 10 and up to 50 LAM acceptors at nine sites, and entered and cleaned on site. Data were further cleaned and analyzed at the Georgetown University Institute for Reproductive Health (IRH) and the Department of Nutrition at the University of Connecticut. Using country-level and pooled data, descriptive statistics and life tables were produced. LAM efficacy in this sample is 100% because there were no pregnancies at any of the participating sites. Satisfaction with the method was high, and the rate of continuation on to another method after LAM was 66.7% at 7 months postpartum. Of the women who had never used family planning prior to LAM, 63.0% went on to use another method of family planning in a timely manner. LAM can be highly effective as an introductory postpartum family planning method when offered in a variety of cultures, health care settings, and industrial and developing country locales. Under conditions of limited client-provider contact, LAM remains effective and leads to acceptance of another method by about two-thirds of the acceptors. Women are able to use LAM effectively without extensive counseling or follow-up, with a high level of user satisfaction.

Adult↗
PubMed1999

Health sequelae of breastfeeding for the mother.

Breastfeeding is known to demand use of maternal nutrient stores, but few comment on the positive health benefits of breastfeeding for the mother. Breastfeeding reduces the risk of postpartum blood loss by increasing the rate of uterine contraction, lowers the risk of postpartum blood loss by increasing the rate of uttering contraction, lowers the risk of postpartum blood loss by increasing the rate of uterine contraction, lowers the risk of premenopausal breast cancer and also reduces the risk of ovarian cancer, reduces lifetime menstrual blood loss, may reduce rate or severity of infections, may reduce the risk of spinal and hip fracture after menopause, and may support bonding with the infant as well as an improved sense of self-esteem and success with mothering. This article reviews the literature on short- and long-term sequelae of breastfeeding for women.

Breast Feeding↗
PubMed1997

Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application.

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to test the acceptability and efficacy of the method. Additionally, the data are used to test new constructs for improvement of method criteria. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, a World Health Organization (WHO) Collaborating Center, and was reviewed and modified in collaboration with the co-sponsors, the World Health Organization and the South to South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM acceptors at 11 sites. Data were entered and cleaned on-site and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics and life tables. The 98+% efficacy of LAM is confirmed in a wide variety of settings. In addition, the results yield insight on the possibility of continued use beyond 6 months. LAM is found to be highly effective as an introductory postpartum method when offered in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country locales. In addition, LAM acceptance complements breastfeeding behaviors without ongoing breastfeeding support services. The parameters studied yield high efficacy and method continuation. Therefore, the basic tenets of the 1995 Bellagio consensus on LAM is reconfirmed and it is recommended that LAM be reconfirmed and it is recommended that LAM be incorporated into hospital, maternity, family planning, maternal and child health, and other primary health care settings.

Adult↗
PubMed1997

Multicenter study of the Lactational Amenorrhea Method (LAM): II. Acceptability, utility, and policy implications.

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to determine acceptability, satisfaction, and utilization in 10 different populations, and to confirm the efficacy of the method. Efficacy data are presented in a companion paper. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, and reviewed and modified in collaboration with the co-sponsors, the World Health Organization, the South-to-South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM users at 11 sites. Data were entered and cleaned on-site, and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics. The overall satisfaction with LAM was 83.6%, and continuation with another method of family planning was shown to be 67.6% at 9 months postpartum, in most cases exceeding previous use of contraception prior to use of LAM. Knowledge and understanding of the method at discontinuation were high, ranging from 78.4 to 88.6% for the three criteria. LAM can be used with a high level of satisfaction and success by women in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country settings. The results confirm that LAM is acceptable and ready for widespread use, and should be included in the range of services available in maternal and child health, family planning, and other primary health care settings.

Adult↗
PubMed1996

Contraceptive use during lactational amenorrhea.

OBJECTIVE: The study uses data from nationally representative sample surveys in developing countries to estimate the overlap between lactational amenorrhea and contraceptive use during the first 6 months postpartum. METHOD: Secondary analyses of survey data were used to tabulate the proportion of the population in lactational amenorrhea among contraceptive users for all women, for postpartum women and for the country as a whole. RESULTS: Among postpartum women, the proportion in lactational amenorrhea was particularly high in Africa and the Near East and lower in Latin America and the Caribbean where breast-feeding practices have declined. The median duration of use for oral contraceptives is also presented as an aid to interpreting the significance of the findings. CONCLUSIONS: The significance of the findings is considered in the context of planning reproductive health services in the postpartum period. Decisions about timing of contraceptive use for postpartum women, while arrived at on an individual basis, also result from program strategies that focus counseling immediately postpartum or at a later interval, such as when menses resume. On a national level the impact of postpartum contraception policies on use of commodities may be substantial.

Adult↗
PubMed1996

Does prenatal breastfeeding skills group education increase the effectiveness of a comprehensive breastfeeding promotion program?

A control/intervention study carried out in Santiago, Chile assessed the impact of five interventions on breastfeeding patterns and duration, and demonstrated a significant increase in full breastfeeding at six months (32 percent to 67 percent). Fifty-nine of 422 post-intervention women were included in a sixth intervention: prenatal group educational sessions emphasizing the skills necessary to initiate and maintain breastfeeding past the neonatal period. A significantly higher percentage of this subset of women were fully breastfeeding at six months compared to those who received only the five basic interventions (80 percent and 65 percent, respectively). The effect was greater among primiparous women. We conclude that prenatal group education with hands-on skills reinforcement is a significant and additive component of breastfeeding support, especially among those who have no previous breastfeeding experience.

Breast Feeding↗
PubMed1996

The use of breast milk substitutes in developing countries: the impact of women's employment.

OBJECTIVES: This study quantified the influence of employment, specifically a mother's employment away from her infant, on the use of breast milk substitutes in developing countries. METHODS: Data from the Demographic and Health Surveys were used to calculate the population attributable risk percentage for use of breast milk substitutes among women employed away from their babies in 15 countries for which suitable data were available. RESULTS: The estimated proportion of breast milk substitute use attributable to employment away from the baby ranged from 0.74% to 20.9% in the various countries. CONCLUSIONS: Employment is not the main determinant of breast milk substitute use. Efforts to improve breast-feeding can be safely targeted at the majority of women who are not employed away from their babies while nevertheless giving appropriate attention to the minority of new mothers who are employed away from their babies.

Adult↗
PubMed1995

The effects on professional practices of a three-day course on breastfeeding.

This study assessed reported changes in clinical breastfeeding support practices following a three-day (approximately 24 hour) course. The course, presented at the Catholic University in Santiago, Chile, included the physiology of lactation and lactational infertility, related policy, clinical skills, the Lactational Amenorrhea Method (LAM), and program-related findings. A questionnaire was sent to all participants and an additional systematic sample was telephoned to assure a statistically valid sample. Sixty-nine percent of respondents reported changes in clinical practices resulting from attendance at the course. The results support the concept, now being advanced by the Baby-Friendly Hospital Initiative, that an 18-24 hour course can change clinical practices.

Breast Feeding↗
PubMed1994

The Lactational Amenorrhea Method (LAM): a postpartum introductory family planning method with policy and program implications.

It is well accepted that breastfeeding contributes significantly to child survival and child nutrition. Healthful child spacing is associated with improved birth outcomes and maternal recovery. On a population basis, breastfeeding may contribute more to birth spacing than all family planning use combined in many countries. However, while breastfeeding does provide a period of infertility, until recently, there was no reliable way for an individual woman to capitalize on this lactational infertility for her own efficacious child spacing. The Lactational Amenorrhea Method (LAM) is a new introductory family planning method that simultaneously promotes child spacing and breastfeeding, with its optimal nutrition and disease preventive benefits for the infant. LAM, as it is called, is based on the utilization of lactational infertility for protection from pregnancy and indicates the time for the introduction of a complementary family planning method. LAM is recommended for up to six months postpartum for women who are fully or nearly fully breastfeeding and amenorrheic, and relies on the maintenance of appropriate breastfeeding practices to prolong lactational infertility, with the concomitant delay in menses return. A recent clinical trial confirmed the theoretical 98% or higher effectiveness of the method and field trials are demonstrating its acceptability. Nonetheless, some demographers and family planning organizations continue to debate its value. The development, efficacy, and sequelae of the method are presented using data from several studies by the authors.

Amenorrhea↗
PubMed1994

Breastfeeding in family planning programs: a help or a hindrance?

Breastfeeding is a major contributor to child spacing and reproductive health, and as such, is a vital women's issue. Further, if breastfeeding levels were to decline, the increase in family planning services that would be required to replace the lost fertility impact would be prohibitive, both in terms of cost and difficulty. This concern places breastfeeding centrally as a family planning policy issues as well. This paper discusses how breastfeeding contributes to child spacing and reduced fertility; the appropriate and timely introduction of complementary family planning methods during breastfeeding; issues and controversies in the support of breastfeeding as a family planning issue in the context of women's concerns, including the concept of exclusive breastfeeding for 6 months, the encouragement and support to maintain breastfeeding after 6 months, and the use of the Lactational Amenorrhea Method (LAM) and other family planning methods in the early postpartum period; and the role of family planning programs in supporting women's informed reproductive health choices.

Amenorrhea↗
PubMed1994

Breastfeeding as a women's issue: conclusions and consensus, complementary concerns, and next actions.

Twelve themes arose during the conference which, when presented to the group in a summary session, were greeted by general consensus and approval. These themes fall into four categories: women and health care; women and other life choices; women and men; and women and political action. Additional concerns that were not included in the 1-day conference are outlined, including a discussion of: (1) respect for the reproductive roles of women, the three 'I's', and other reproductive health issues; (2) a 7-stage approach to women's nutrition; (3) the supervisory role of the health care provider versus a role as a creator of self-efficacy; (4) the cost of breastfeeding; and (5) the impact on the environment. Conclusions and next actions also are presented for consideration.

Breast Feeding↗
PubMed1993

Knowledge, attitudes, and practices of obstetricians-gynecologists regarding the prevention of human immunodeficiency virus infection.

OBJECTIVE: To determine the knowledge, beliefs, attitudes, and practices of obstetricians-gynecologists regarding human immunodeficiency virus (HIV) prevention. METHODS: Office-based obstetricians-gynecologists in the Washington, DC metropolitan area who reported providing primary care were interviewed by telephone. The survey response rate was 62% (N = 268). RESULTS: The percentages of obstetricians-gynecologists who reported regularly assessing the HIV risk of new adolescent and adult patients were 67 and 40%, respectively. Seventy-two percent reported regularly counseling patients at risk to use condoms for vaginal intercourse, and 60% regularly counseled patients at risk to limit their number of sexual partners. The level of general risk-factor assessment and confidence in the ability to reduce patients' HIV risk were the strongest correlates of the frequency and thoroughness of HIV risk assessment and counseling. CONCLUSIONS: The percentage of obstetricians-gynecologists who assess and counsel patients about HIV risks is below the 75% goal for the year 2000 established by the United States Department of Health and Human Services. Continuing medical education for obstetricians-gynecologists is needed to improve their knowledge and skills in HIV prevention.

Adult↗