Previous pregnancy loss and lactating behaviors: a post-hoc analysis of the Herbal supplements in Breastfeeding InvesTigation (HaBIT)Perinatal grief,Perinatal Death,Intrauterine death,Stillbirth,Bereavement care,Care,Indigenous women,Care experiences

Previous pregnancy loss and lactating behaviors: a post-hoc analysis of the Herbal supplements in Breastfeeding InvesTigation (HaBIT)Perinatal grief,Perinatal Death,Intrauterine death,Stillbirth,Bereavement care,Care,Indigenous women,Care experiences

Alessandra Bettiol (1), Niccolò Lombardi (1), Giada Crescioli (1), Roberto Bonaiuti (1), Claudia Ravaldi (2,3), Alfredo Vannacci (1,2)

(1) Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy; (2) CiaoLapo Charity for Healthy Pregnancy, Stillbirth and Perinatal Loss Support, Prato, Italy; (3) Department of Health Sciences, University of Florence, Florence, Italy

Background:
Perception of pregnancy- and breastfeeding-related difficulties and consequent use of complementary and alternative medicines (CAMs) may differ in bereaved women, in force of the distress related to previous loss. This Herbal supplements in Breastfeeding InvesTigation (HaBIT) post-hoc analysis explored the impact of previous pregnancy loss on the lactating behaviors and on the use of CAMs during breastfeeding.

Methods:
A web-based survey was conducted among lactating women with no previous alive child, resident in Tuscany (Italy). Data on lactating behaviour and on CAMs use were collected and evaluated among women with previous pregnancy loss as compared to control women.

Results:
Out of 476 women answering the questionnaire, 233 lactating women with one child were considered. Of them, 80 had history of pregnancy loss. Caesarean birth was significantly more frequent among women with history of pregnancy loss as compared to controls (41% vs 22%; p=0.004). Proportion and length of exclusive breastfeeding, and occurrence of breastfeeding-related complications, were comparable among the two cohorts. More than half of women used CAMs during breastfeeding. Use of CAMs was more frequent among women with previous pregnancy loss (54% vs 68%; p=0.050), specifically considering herbal preparations (16% vs 30%; p=0.018). Major advisors for CAMs use were midwives.18% and 23% of women without and with history of pregnancy loss declared no clear perception on CAMs efficacy and safety.

Conclusion:
Overcoming the social taboo of pregnancy loss, and training healthcare professionals for an adequate management of the perinatal period is essential for an effective and safe care. Despite the common use and advise for CAMs use during breastfeeding, it is important to acknowledge that limited evidence supports their safety and efficacy during such critical period.

Ethics statement:
According to Italian regulation, for this type of studies the approval by the Ethics Committee is not required (GU n. 76 March 31, 2008); data were collected in keeping with General Data Protection Regulation of European Union (GDPR, EU 2016/679) and written informed consent was obtained from all participants.


International Stillbirth Alliance, Annual Conference on Perinatal Mortality and Bereavement Care, Madrid, Spain. October 5-6th, 2019.

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