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OBJECTIVE To compare breastfeeding duration in postpartum mothers randomized to a behavioral educational intervention versus enhanced usual care. STUDY DESIGN Randomized trial. Self-identified black and Latina early postpartum mothers were randomized to receive a behavioral educational intervention or enhanced usual care. The two-step intervention aimed to prepare and educate mothers about postpartum symptoms and experiences (including tips on breastfeeding and breast/nipple pain), bolster social support and self-management skills. Enhanced usual care participants received a list of community resources and received a 2-week control call. Intention-to-treat analyses examined breastfeeding duration (measured in weeks) for up to six-months of follow-up. This study is registered with clinicaltrial.gov (NCT01312883). RESULTS Five hundred forty mothers were randomized to the intervention (n=270) versus controls (n=270). Mean age was 28 (range 18–46); 62% were Latina and 38% were black. Baseline sociodemographic, clinical, psycho-social, and breastfeeding characteristics were similar among intervention versus controls. Mothers in the intervention arm breastfed for longer duration than controls (median of 12.0 weeks versus 6.5 weeks, respectively, p =.02) Mothers in the intervention arm were less likely to quit breastfeeding over the first six-months postpartum (hazard ratio of 0.79; 95% CI 0.65–0.97). CONCLUSION A behavioral educational intervention increased breastfeeding duration among low-income, self-identified black and Latina mothers during the six-month postpartum period.

Objectives Using data from two postpartum depression randomized trials, we examined the association between postpartum depressive symptoms and parenting practices among a diverse group of mothers. Methods We examined the association between safety practices (back sleep position, car seat use, smoke alarm), feeding practices (breastfeeding, infant intake of cereal, juice, water), and health care practices (routine well child and Emergency Room (ER) visits) with 3-month postpartum depressive symptoms assessed using the Edinburgh Depression Scale (EPDS≥10). Results Fifty-one percent of mothers were black or Latina, 33% had Medicaid, and 30% were foreign born. Depressed mothers were less likely to have their infant use back sleep position (60% vs. 79%, p<.001), always use a car seat (67% vs. 84%, p<.001), more likely to feed their infants water, juice, or cereal (36% vs. 25%, p=.04 respectively), and to bring their babies for ER visits (26% vs. 16%, p=.03) as compared with non-depressed mothers. In multivariable model, depressed mothers remained less likely to have their infant use the back sleep position, to use a car seat, and to have a working smoke alarm in the home. Conclusions Findings suggest the need to intervene early among mothers with depressive symptoms and reinforce positive parenting practices.

Findings suggest that SI among a relatively healthy group of new mothers occurs with some frequency. Mothers with a history of depression and antepartum complications may be at increased risk.

Objective To measure stigma associated with four types of postpartum depression therapies and to estimate the association between stigma and the acceptance of these therapies for black and white postpartum mothers. Methods Using data from two postpartum depression randomized trials, this study included 481 black and white women who gave birth in a large urban hospital and answered a series of questions at 6-months postpartum. Survey items included socio demographic and clinical factors, attitudes about postpartum depression therapies and stigma. The associations between race, stigma, and treatment acceptability were examined using bivariate and multivariate analyses. Results Black postpartum mothers were less likely than whites to accept prescription medication (64 vs. 81%, p = 0.0001) and mental health counseling (87 vs. 93%, p = 0.001) and more likely to accept spiritual counseling (70 vs. 52%, p = 0.0002). Women who endorsed stigma about receipt of postpartum depression therapies versus those who did not were less likely to accept prescription medication, mental health and spiritual counseling for postpartum depression. Overall black mothers were less likely to report stigma associated with postpartum depression therapies. In adjusted models, black women versus white women remained less likely to accept prescription medication for postpartum depression (OR = 0.42, 95% CI 0.24-0.72) and stigma did not explain this difference. Conclusions Although treatment stigma is associated with lower postpartum depression treatment acceptance, stigma does not explain the lower levels of postpartum depression treatment acceptance among black women. More research is needed to understand treatment barriers for postpartum depression, especially among black women.