Durham Connects Acknowledged as an HomVEE Program

After rigorous evaluation of program results, Durham Connects is acknowledged as one of the few "Home Visiting Evidence of Effectiveness" (HomVEE ) programs in the USA. The Durham Connects staff was one of the first organizations in the USA to receive HUG Your Baby training and recently completed “The Roadmap to Breastfeeding Success: Teaching Child Development to Extend Breastfeeding Duration.”

Durham Connects has now endorsed “The Roadmap to Breastfeeding Success"!

 “Our team of home visiting nurses recently took the ‘The Roadmap to Breastfeeding Success’ course from Hug Your Baby. The course provided valuable information on how the infant's developmental changes affect breastfeeding. This gave us insight on how to best help moms recognize and manage their babies' resting, active, and fussy times. The course has enhanced our ability to teach all moms, whether they choose to breastfeed or not.” Paula Wright, RN, BSN, IBCLC; Director of Clinical Services

Parent's Faces "Lights Up" When They Get The HUG from New Certified HUG Teacher!

Rebeca Perez is a Certified Parent Educator in Chattanooga Tennessee, serving both English and Spanish speaking families.

I am so delighted to have integrated HUG Your Baby into my home visits. Recently, I offered my first HUG Your Baby class to our families during our monthly group connection. I showed the HUG DVD in English and Spanish. We reviewed all 3 newborn “Zones”, talked about identifying SOS’s (Signs of Over-Stimulation), and how to help their babies get to the “Ready Zone” in order to play. 

It was amazing to see the look on their faces and their interest in learning these techniques. I was especially happy to see the fathers become involved when we were practicing calming techniques with a doll. Parents expressed how happy they were to have attended to class. They expressed delight in learning how to understand their babies’ body language in order to better bond with their babies.

I also had the privilege to teach HUG Your Baby to a few families during a home visits. They had many questions about their babies’ behavior since that they were first time parents. These new parents were able to learn how important is to learn to recognize their infant's cues,  "Zones “and SOS’s.

In one of the visit tjhe baby started crying after being awake for a while. His father immediately thought that the baby was hungry. However, after learning about the SOS’s he was able to understand that the baby was over-stimulated instead. The baby's mother was happy to use the comforting/calming techniques of holding the baby’s hand to his chest, swaddling the baby, and talking to him softly. They had “ah ha” moment when they saw their baby calming down and falling to sleep. 

Another mom informed me during our second visit that distinguishing the baby’s “Active/Light” and “Still /Deep “sleep allowed her baby to stay calm and to sleep longer hours at night. 

I am so excited to help empower families in my community by teaching HUG Your Baby!

Certified HUG Teacher Helps Teen Mother Bond with Her Baby

Emily Walden is a labor, delivery, and postpartum RN in Olmsted Township, Ohio. Her patients are especially lucky because Emily is also a DONA-trained Birth Doula. She has just become a Certified HUG Teacher as yet another way to learn from and serve the young families in her community. Here is her story.

I was on the search of obtaining contact hours for ICEA certification and DONA recertification when I stumbled across HUG Your Baby, a program I had not heard about before. I immediately turned to my experience as a mother of a thirteen-week-old and recognized many of the behaviors Jan mentioned in the class. I was learning information to not only share at work, but to apply to my own baby as well. And, The HUG tips and techniques worked great! I noticed that after observing and understanidng her behavior, I felt even more bonded than before and breastfeeding improved. I felt more confident and had a more complete understanding of what she was "saying" with her behavior.

Working as a Labor and Delivery RN has always been very rewarding. But, after my HUG training I am better able to help a mother bond with her baby after I have helped bring that life into the world is priceless.

Recently I had a visit was with a young adolescent mother having her first baby. This young mother was very passive and quiet in her personality. It was challenging for me to care for this couplet because I felt I needed to watch for emotional cues indicating distress in both the baby and the mother. It was as if both were giving me S.O.Ss (Signs of )ver-Stimulation. I had to be vigilant in my observations.

This young mother, only one day postpartum, was hesitant and unclear when her baby needed to eat. She would wait until he was wailing to try and bring him to breast.  Of course, she would then get frustrated because he wouldn’t latch. I could see that this mother wanted to breastfeed and  that the baby really wanted to eat! I discussed the baby's "Ready" and "Rebooting Zones" and suggesting that waiting to feed in the "Rebooting Zone" did not seem to be working well. The young mother was immediately boosted in her confidence level after seeing these S.O.Ss. She then was able to feed her baby for 45 minutes.

We then discussed the many triumphs and challenges of life with a newborn during the first few weeks of life. She really was thankful for the insight I was able to give and  was able to then open up and share her feelings of inadequacy as a “teenage mother.” Her whole face changed as I watched her bond with her baby. It was a gift for me to be a part of supporting this young mother. I value the teachings I was able to give her and feel more knowledgeable in my profession as a labor and delivery nurse. Thanks Jan!

Italy's First Certified HUG Teacher!

Benedetta Costa has been involved with International Association of Infant Massage for thirty years. A founding member of the Italian Association of Infant Massage, Benedetta is now the first Certified HUG Teacher in Italy. Read about her experiences with The HUG!

In 1983 I trained as an infant massage instructor with Vimala McClure, author of "Infant Massage for Loving Parents". One of the most important lessons I received from Vimala is to recognize the value of "asking permission" from the baby before starting a massage. Vimala says that "asking permission" is a wonderful way to show respect and love for the baby and to see each baby as a person with the right and freedom to say Yes or No! The challenge, then, is to be able to see how the baby says that he is ok to receive a massage or that he is not available and needs a break. Understanding babies' cues--and helping parents read their baby's body language--are fundamental to teaching and learning the art of infant massage. 

Benedetta and Jan at 
2014 training in Bologna  
Last year Jan Tedder presented HUG Your Baby (Help, Understanding and Guidance for Young Families) at the Annual General Assembly in Bologna. All participants immediately "got" the connection between The HUG concepts and their work teaching parents to see the best time to massage their babies. Participants understood that helping, understanding and guiding parents to recognize infant cues, "Zones," and "SOSs - Signs of Over-Stimulation" is crucial. 

In Bologna I began the Certified HUG Teacher program in order to learn more about HUG Your Baby and to promote its use in my country with parents and with Infant Massage Instructors. 

Benedetta with her grandson
My first training experience was very close to home, and to my heart: the birth of my grandson! I was delighted to watch my daughter's sensitivity to her son's SOSs. What a difference it made to know when to interact with her son and when to just hold him closely skin-to-skin. 

After my grandmother responsibilities slowed down a bit, I returned to studying the CHT program.

Recently, I offered my first HUG Your Baby class to four pregnant women, a grandmother of a three-day-old, and a four-year-old sibling. I showed the Italian HUG DVD and reviewed "Zones," "SOSs," and infant crying (which seemed especially important to participants). When we practiced calming techniques with dolls, I was especially delighted to see the young sibling join in the practice session! Class participants gave positive feedback about the class; they thought it was a good way to include extended family, and would "Absolutely" recommend it to family and friends.

Benedetta's first HUG Your Baby class
On my first home visit as a HUG teacher The HUG helped a mother and grandmother calm a crying baby and distinguish their baby's "Active/Light" and "Still/Deep" sleep patterns. It will be interesting to hear more "HUG stories" from this mother and grandmother when they attend my next HUG Your Baby class.

During my second HUG home visit I enjoyed seeing a baby and her mother show beautiful face-to-face interaction. This mother was surprised to see that her baby could imitate her sticking her tongue out. I attempted to have the baby turn when mother called the baby's name. Though this young baby got quiet and still, he was not yet able to turn to her mother's voice. I now know that this is normal infant behavior and could reassure this mother that she will see her baby's abilities continue to grow and develop over the next week or so. 

I have great hopes for sharing HUG Your Baby with parents and colleagues across Italy. The HUG DVD is now available in Italian and we are working toward translating the HUG online course for professionals.

Though today’s parents have access to the Internet, numerous books, pediatricians, friends and grandmothers, they still have much to learn and need our support. Since their baby can always be their GREATEST teacher, parents need and want to observe and understand their baby's body language. HUG Your Baby training and resources, I believe, can give new parents and the professionals who serve them, information and skills to make all the difference!
Doesn't Benedetta's grandson make you want to give The HUG!

Certified HUG Teacher Brings The HUG Home and to Hawaii!

Suzanna Baker is a Certified Labor Doula, Certified Breastfeeding Specialist also in a Certified Breastfeeding Counselor course, and on her path to becoming an IBCLC! She is also a Baby Signs Infant Sign Language Instructor and has an Early Childhood 0-18 mth focus. She is the mother of 5 children and a military wife currently stationed in Oahu, Hawaii.

I am ecstatic to be able to share the concepts of HUG Your Baby with the families I work with. I first learned of HUG Your Baby via the Cappa website and upon further investigation it seemed it would fit well with my work.

HUG Your Baby Zones and SOSs are such a wonderful and easy to understand tool for early parenting. This information is already clicking with so many of my new parents! You can just see the "ah ha" moments parents have when you explain the SOSs and Zones as it relates to their individual baby. The relief new parents get when you give them this information and relate it specifically to their baby is just priceless! There is nothing better than instilling more confidence in a Mother/new baby bond. It's so vital. Even as a Mom of 5 who deals with this age group every day, I learned many new concepts and tricks to deal with my own infant. 

It's always a struggle in our culture to promote lactation when many moms are not aware of normal newborn cues and behaviors. Breastfeeding education is so important and I feel HUG classes will do wonders for the Mother/infant bond as well as Father/infant and extended family. I plan to teach HUG Your Baby concepts at local classes, at pregnancy crisis center and homeless shelters. These locations are always in need of lactation classes, parenting classes, childbirth education classes.  I think families who follow HUG Your Baby will see a longer breastfeeding duration and that is a wonderful thing for the baby and the family!

New Certified HUG Teacher Discovers that The HUG Enhances Nighttime Teaching of Sleepy Mums

Denise Harris is a midwife from Melbourne Australia. She has incorporated HUG Your Baby into her postpartum work with new mums. She shares this essay to give us a taste of her experiences using HUG resources and techniques.

I am a registered midwife, in Melbourne Australia. I work in a hospital where my main contact with new parents is birth and the first two nights, as I work permanent night duty. Therefore, I have contact predominantly with Mums and not the whole family. I find this often puts these Mums in a very vulnerable position as they only have me to rely on for education, information and extended care of their newborn, after family members have left for the day.  These Mums are tired and feel the overwhelming reality of caring for a newborn. 

I was first attracted to the Hug Your Bay conference because of its name. I was finding that many women did not want to hold their babies because they were scared of spoiling them! I needed to find more information to try and convince them this is okay. Though it was interesting to learn more about normal newborn behaviour, the greatest thing I learned was about MY behaviour. I learned that no one wants to hear what parenting is like for everyone, but only  what it is like them and their baby. After learning the baby's name, my nest step was DO actions instead of all talk. 

I would ask the Mum if they thought they knew what was going on with their baby, and most Mums at this stage would answer that"my baby is hungry and I'm worried I don't have enough milk". I would agree that the baby's behaviour can be confusing and then go on to explain the process of initiating lactation and the baby's role in this. I would also take time to use the techniques I learned to calm the baby.  I try to keep this all very brief, and condensed as it is usually the middle of the night and these Mums are all getting very tired, some even exhibiting S.O.S.! I try to speak in a calm reassuring manner and I find a much more positive response from these Mums.

The other most common problem I encounter is that the baby will fall asleep at the breast the moment he latches on. then waking up the minute they are taken away from the breast. I usually have six women and newborns in my care, and cannot spend a great deal of time with one mum. However if a mum is struggling, I do my best to spend more time with the mum and bub to show further settling techniques such as patting the baby in bed and rocking the baby. This seems to give these mums more "tools" in managing their babies and increase their confidence.

The very first time I made an effort to incorporate The HUG into my practice,I discovered three of the mothers I had been caring for had gone home a night earlier than planned discharge. I hope that my new approach contributed to their confidence about going home earlier than planned. 

In the near future, I hope to my further my education and become a Maternal and Child Health Nurse. In this field I will see mothers and babies for the first few years of the lives instead of the first few days. I hope to also run first time mother groups where I can incorporate and teach Hug Your Baby. This will hopefully help many more new parents become the good Mums and Dads they want to be!

New Parents Need Help with a Crying Baby

(Sample E-newsletter from The Roadmap to Breastfeeding Success lactation support program.)

Huge tears rolling down Maria’s face say it all. “Anna cries all the time, and so do I!” this young mother tells her husband. As if on cue, Anna seems to wind up for a big one. Her face gets red, her hands start to tremble, and her legs stiffen. Though Maria knew that all babies cry, she never imagined how overwhelmed she would feel when her tiny newborn enters the fussing/crying, "Rebooting Zone."

Maria's husband comments, "That baby must be hungry!" And, though Maria has been committed to breastfeeding she now wonders if her baby might need a little formula. Surely a bottle or two a day of that expensive "gas-free" formula would help her crying baby.

But, Maria vaguely remembers that the birth center's lactation consultant (LC) had mentioned something about extra crying spells during their prenatal breastfeeding class. Didn't that "Roadmap" handout say something about crying? Maria shuffles through some papers beside the couch. Yes, it  says to "anticipate increased crying" at two weeks. Maria decides to get a bit more advice before buying even one can of formula. 

"I'm desperate! Just tell me what TO DO!" Maria asks the LC when she and her husband arrive at the clinic the next day.

The Science: "Just Tell Me What T.O. DO!"
Most normal, healthy babies begin to cry more around forty-two weeks gestation, or two weeks after birth (if the baby was born full-term). Babies typically move from crying two hours a day to crying three hours a day by six weeks of age. Then their crying tapers to about one hour a day by twelve weeks of age.

The LC shares with Maria some easy-to-remember tips she just learned:
 Talk to your baby. Lean over and use a persistent, sing-songy voice close to her ear. Give your baby a few seconds to notice and respond to your voice. 
– Observe your baby's efforts to contribute to his own calming. Many parents are surprised to learn that babies have instinctive behaviors that help them calm down. She might bring her hand to her mouth (perhaps with your help) and suck her finger or thumb. Or she may make sucking movements and start to quiet. 

Another baby may look like she’s taking up sword fighting (the fencing reflex): Her head turns to the side, one arm and one leg extend, while the other arm and leg flex. This instinctive maneuver helps some babies start to calm. Finally, some babies use behavioral SOSs (Signs of Over-Stimulation) to turn off the excessive stimulation around them. The baby may stare into space or appear drowsy and then begin to settle. 

DO – If the baby is still crying, a parent's help is needed. Hold her arms against her chest and continue that quiet, persistent talking. Encourage the baby to suck your finger or the breast, or swaddle her safely. Techniques for safe swaddling include:
  1. Bend the knees upward and rotate them outward to protect the hips. (Here is the International Hip Dysplasia Institutes's link to safe swaddling.)
  2. Do not swaddle tightly, or for long periods of time.
  3. Monitor the baby's temperature to avoid over-heating.
  4. Never put a swaddled (or un-swaddled) baby to sleep on his stomach.
  5. Stop swaddling baby once she can roll over (at about 3-4 months old).
If parents take these actions, one step at a time, mothers and fathers will soon discover what is most comforting to their baby. 

Click here to watch a music video of a father using skills he learned to comfort his crying baby.

An "Ah-Ha" Moment for these Young Parents
When little Anna starts to cry at her clinic visit the next morning, the LC leans over the baby and speaks quietly into her ear. Anna looks surprised but continues to cry. She smacks her lips a moment and then quiets right down when the LC holds her tiny but strong arms securely against her chest. 

Maria and her husband can’t believe their eyes (or ears!). Anna's father gently holds his baby's hands in this comforting position and sees his now peaceful baby look right up into his eyes. Maria then brings the baby to the breast for a good feed before their ride home. “We are a good team,” she tells the LC. “We’ll work this out togetherand without any formula!"

(Click here for further information about online lactation training and resources.)

© HUG Your Baby 2015

Variables Impacting Breastfeeding Duration

By Jan Tedder, BSN, FNP, IBCLC; President of HUG Your Baby; See Roadmap to Breastfeeding Success Online Course

Research confirms that a woman's misunderstanding of normal child development is an important, and often over-looked, cause for abandoning breastfeeding. Though these issues are covered in depth in The Roadmap to Breastfeeding Success online course, we must be aware of the other, complex variables that may impact a woman's ability to initiate breastfeeding and to continue to breastfeed.

Demographic variables
Demographic variables that make women less likely to begin and continue breastfeeding include: prenatal smoking (Bertino et al., 2012); lower socio-economic, racial or ethnic status; having an unplanned pregnancy or not having a partner; being less-educated (Li et al., 2008); participating in a WIC program (Thulier & Mercer, 2009); and being obese, which is associated with a delay in milk coming in (Stuebe et al., 2014).

Social Variables

Other research moves demographic data to a wider screen by identifying particular social variables that impact initiation and duration of breastfeeding: worries about breastfeeding in public (Stuebe & Bonuck, 2011); lack of partner support and marital distress (Stuebe & Bonuck, 2011; Hinsliff-Smith et al., 2014); giving birth at a non-Baby-Friendly hospital; and returning to work.

We know that breastfeeding rates increase when pregnant women get together with successful breastfeeding mothers. In addition, an important study demonstrates that women who observe breastfeeding role models through videos (and who receive praise from their partners or their own mothers for breastfeeding) have significantly higher levels of confidence in and commitment to breastfeeding than do mothers who lack this kind of support (Kingston, 2008).

It is important to ask what kind of help and support new mothers need. A study from China showed that a grandparent in the home, among other variables, is associated with shorter breastfeeding duration (Liu et al., 2013). Research in Japan showed that the more fathers were involved with care of their infant the less anxiety their partners had—but the more formula the baby received (Ito et al., 2013). Both of these studies may indicate that loved ones need to be shown ways other than feeding to connect with a baby and help a new mother.

Biological Variables
Biological variables that impact breastfeeding include: a mother having physical challenges such as sore nipples, engorgement, mastitis, or plugged ducts before a baby is four weeks of age.

Remember that a woman who identifies any breastfeeding concerns at day 3 and 7 postpartum is less likely to be successfully breastfeeding at 2 months (Wagner et al., 2013). Mothers with early complaints need careful follow-up and ongoing support.

Interesting work by Kathleen Kendall-Tackett makes a connection between a woman’s experience of postpartum pain and its impact on breastfeeding (Kendall-Tackett, 2007). She explains that pain increases the body’s inflammatory process. This inflammatory process causes neuro-hormonal changes that are associated with depression. Kendall-Tackett concludes that pain from c-sections, or with breastfeeding, may create the conditions that result in postpartum depression.

Studies also show that mothers who have pain the first two weeks postpartum—and do not receive the help they need—are more likely to have postpartum depression at two months (Watkins et al., 2011). These studies confirm the importance of getting immediate lactation help for women having postpartum pain.

As one would expect, physical problems in the baby—such as prematurity, illness, or tongue-ties—also contribute to decreased breastfeeding duration and require both special medical care and more lactation support.

Psychological Variables
Though more research has been focused on how psychological variables impact the initiation rather than the duration of breastfeeding (De Jager et al., 2012), current literature suggests that at least four psychological issues influence breastfeeding success: postpartum depression, a mother’s intention and confidence to breastfeed, her sensitivity to her baby, and maternal-child attachment.

Postpartum depression occurs in 13% of mothers (Borra et al., 2014). Work by Kathleen Kendall-Tackett and others explores how the hormones of pregnancy help protect women from postpartum depression, a process, they say, that explains why women who breastfeed have a lower incidence of depression (Kendall-Tackett, 2010). 

In addition, other research shows that women with postpartum depression or anxiety often misread their baby’s body language (Arteche et al., 2011). Studies show that a woman with postpartum depression or anxiety can accurately identify her baby’s distressed face, as do mothers without these psychological conditions. However, the depressed or anxious mother will see her baby’s neutral face as distressed. And, this same mother seems unable to see her baby’s happy face (Arteche et al., 2011) Therefore, helping a mother with postpartum depression accurately read her baby’s body language may increase both that mother’s confidence and her breastfeeding duration.

Second, a women’s intention to breastfeed is a contributing factor to breastfeeding duration. Women who decide prenatally to breastfeed are more likely to be successful breastfeeding mothers (Meedya et al., 2010). Besides identifying an expectant woman's intention to breastfeed, helping her also say how long she plans to breastfeed has been shown to be important.

However, it is important to bear in mind that if a woman intends to breastfeed, and then is unsuccessful in meeting her breastfeeding goals, she will suffer a higher incidence of depression than if she had not intended to breastfeed in the first place (Borra et al., 2014). This research reinforces the need for immediate and effective breastfeeding support as soon as any breastfeeding problem arises.

Lack of confidence leads many women to give up breastfeeding when there are challenges to overcome. Fortunately, work by Dr. T. Berry Brazelton and others (Kadivar & Mozafarinia, 2013) demonstrates the remarkable power of using the baby’s behavior to enhance the confidence of young parents (Brazelton & Sparrow, 2006; Nugent et al., 2007).

Third, research indicates that prenatal women who establish their intention to breastfeed exhibit increased sensitivity to their infants’ cues. In addition, these mothers show an increase in both their duration of breastfeeding and in their exclusive breastfeeding rates (Thulier & Mercer, 2009; Tharner et al., 2012).

Helping a father experience his baby’s ability to interact, or a mother see her baby’s ability to turn toward her face when she calls her name, are techniques that have been shown to increase parent-child bonding and to boost parent confidence. Other studies show that mothers who are highly confident about breastfeeding are more likely to be exclusively breastfeeding at one week and at four months postpartum (Blyth et al., 2009).

Fourth and finally, the issue of maternal-child attachment and breastfeeding is important, both to parents and to the health care providers who serve them. A 2012 study used the well-accepted Ainsworth Sensitivity Scales to assess the impact of breastfeeding on attachment and continued breastfeeding. Mothers who breastfeed to six months demonstrate the highest levels of maternal sensitivity and secure attachment to their baby (Tharner et al., 2012).

Arteche, A., et al. (2011). The effects of postnatal maternal depression and anxiety on the processing of infant faces. Journal of Affective Disorders, 133(1-2), 197-203.

Bertino, E., Varalda, A., Magnetti, F., Nicola, D., Cester, E., Occhi, L., Perathoner, C., Pradi, G., Soldi, A. (2012). Is breastfeeding duration influenced by maternal attitude and knowledge? A longitudinal study during the first year of life. Journal of Maternal-Fetal and Neonatal Medicine, 25(53), 32-36.

Blyth, R., Creedy, D., Dennis, C. et al. (2009). Effects of maternal confidence on Breastfeeding duration: An application of Breastfeeding self-efficacy theory. Birth, 29 (4), 278-284.

Borra, C., Iacovau, M. & Sevilla, A. (2014). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intention. Maternal Child Health Journal, Retrieved from http://link.springer.com/article/10.1007%2Fs10995-014-1591-z#page-1

Brazelton, T. & Sparrow, J. (2006). Touchpoints: Birth to 3. New York, NY: Perseus.

De Jager, E., Skouteris, H., Broadbent, J., Amir, L, Mellor, K. (2013). Psychological correlates of exclusive breastfeeding: A systematic review. Midwifery, 29(5), 506-518.

Hinsliff-Smith, K., Spencer, R., Walsh, D. (2014). Realities, difficulties, and outcomes for mothers choosing to breastfeed: Primigravid mothers’ experiences in the early postpartum period (6-8 weeks). Midwifery, 30(1), 14-19.

Ito, J., Fujiwara, T., Barr, R. (2013). Is paternal infant care associated with breastfeeding? A population-based study in Japan. Journal of Human Lactation, 29(4), 491-9.

Kadivar, M. & Mozafarinia, M. (2013). Supporting fathers in a NICU: Effects of the HUG Your Baby program on father’s understanding of preterm infant behavior. Journal of Perinatal Education, 22(2), 113-119.

Kendall-Tackett, K. (2010). Four research findings that will change what we think about perinatal depression. Journal of Perinatal Education, 19(4), 7-9.

Kendall-Tackett, K. (2007). A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal, 2(6).

Kingston, D., Dennis, C., Sword, W. (2007). Exploring breastfeeding self-efficacy. Journal of Perinatal and Neonatal Nursing, 21(3), 207-215.

Li, R., Fein, S., et al. (2008). Why mothers stop breastfeeding: Mothers’ self-reported reasons for stopping during the first year. Pediatrics 122, S69-76.

Liu, P., Qiao, L., Xu, F., Zhang, M., Want, Y., Binns, C. (2013). Factors associated with breastfeeding duration: a 30-month cohort study in northwest China. Journal of Human Lactation, 29(2), 253-9.

Meedya, S., Fahy, K., Kable, A. (2010). Factors that positively influence breastfeeding duration to 6 months: A literature review. Women Birth, 23(4), 135-145.

Nugent, K., Keefer, C., Minear, S., Johnson, L. (2007). Understanding newborn behavior and early relationships: The Newborn Behavioral Observation System Handbook. Baltimore, MD: Paul H. Brookes Publishing Company.

Stuebe, A., Horton, B., Chetwynd, E., Watkins, S., Grewen, K., Meltzer-Brody, S., (2014). Prevalence and risk factors for early, undesired weaning attributed to lactation dysfunction. Journal of Women’s Health, 23(5), 404-12.

Stuebe, A., Bonuck, K. (2011). What predicts intent to breastfeed exclusively? Breastfeeding knowledge, attitudes, and belief in a diverse urban population. Breastfeeding Medicine, 6(6), 413-420.

Tharner, A., Lujil, M., Raat, H., Ijzendoorn, M., Bakermans-Kranenburg, M., Moll, H., Jaddoe, V., Hofman, A., Verhulst, F., Tiemeier, H. (2012). Breastfeeding and its relation to maternal sensitivity and infant attachment. Journal of Developmental & Behavioral Pediatrics, 33(5), 396-404.

Thulier, D. & Mercer, J. (2009). Variables associated with Breastfeeding duration. Journal of Obstetric, Gynecologic, & Neonatal Nursing, May/June 38(3), 259-268.

Wagner, E., Chantry, C., Dewey, K., Nommsen-Rivers, A. (2013). Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics, 132(4), e 865-875.

Watkins, S., Meltzer-Brody, S., Zolnoun, D., Stuebe, A. (2011). Early breastfeeding experiences and postpartum depression. Obstetrics & Gynecology, Aug 118 (2 Pt 1), 214-21.

©HUG Your Baby 2015