Milk Compositions of Mothers Who Breastfeed as Tandem
Milk Compositions of Mothers Who Breastfeed as Tandem
The impact of tandem breastfeeding on the health of mothers and babies is a matter of
 curiosity. It is stated in the literature that there are few studies that examine the results
 of tandem breastfeeding in terms of mother, newborn and other baby after birth, and that
 there are no negative consequences of breastfeeding in terms of mother, newborn and older
 baby at two different ages. Research shows that while it is possible for mothers to continue
 breastfeeding by counselling to them based on evidence-based information, most of them have
 ended breastfeeding. It is the responsibility of nurses to make this process more successful
 and seamless for both mothers and babies. In tandem breastfeeding, the nurse should advise
 the mother on her own feeding and breastfeeding, and should refer her to her physician if she
 considers it necessary. There is no clear and up - to-date source showing changes in mother's
 milk over time (24-72 hours-one month), production time (colostrum and mature milk), changes
 in milk composition in tandem breastfeeding in the current literature, and this study is
 original with this aspect.
Background: Considering the health benefits both for the infant and the mother, American
 Academy of Pediatrics (AAP) and World Health Organization (WHO) recommend only mother's milk
 in the first six months of life and then continuing breastfeeding for at least two years with
 complementary feeding (Eidelman, 2012; Topal et al., 2011). A review of the breastfeeding
 status of babies in Turkey reveals that breastfeeding is common, but it is not at a
 satisfactory level in terms of the length of time babies are given mother's milk only or in
 the total length of breastfeeding. One of the most important reasons is early start of
 complementary food or early weaning (TNSA2018). In 5.7 to 29.2% of the cases where
 breastfeeding was terminated early, the mother became pregnant again during the lactation
 period. Both mothers and healthcare professionals are confused as to whether breastfeeding
 should continue in pregnancy. Moreover, the field literature does not offer any information
 about any changes in the milk composition of a mother breastfeeding two babies of different
 ages at the same time (tandem breastfeeding). It is also known that some mothers who get
 pregnant during lactation period or with an interval of less than two years do not wean the
 first-born and continue breastfeeding both babies at the same time (Bøhler & Ingstad, 1996;
 Moscone & Moore, 1993; O'Rourke & Spatz, 2019). In light of this information, this study
 project is aimed to explore any differences in the composition (fat, protein, lactose, water,
 and casein) and density of milk during pregnancy or tandem breastfeeding.

 Method: The universe of the study is planned to consist of all multigravid women admitted to
 the Obstetrics and Gynecology Clinic of the Sakarya University Education and Research
 Hospital, Turkey, breastfeeding postpartum in tandem and not breastfeeding during pregnancy.
 The sample of the study, including 15 control and 15 experimental groups, 30 mothers to be
 selected according to the inclusion criteria. groups will be determined by simple random
 sampling method. In order to assign the mothers who meet the selection criteria into the
 experimental group or the control group, the randomization method with a computer program
 (http://www1.assumption.edu/users/ avadum/applets/RandAssin/Groupgen.html) was used. Data
 collection is planned to take place in two stages for control and experimental groups. The
 first stages correspond to 24 to 72 hours postpartum. This is to be accomplished through
 house calls upon appointment with the mothers. During the house call, 15 ml milk is obtained
 from the mother with suitable methods (Appendix…) and preserved in a sterilized milk
 collection container. At the end of birth, 15 ml colostrum will be taken from the mother,
 instead of 30 ml, so that the babies in both groups benefit more from colostrum. Then, it is
 analyzed within the next 3 hours in terms of its composition (moisture, protein, oil,
 lactose) and to the Tubitak Mam Research Center to the Nutrition Lab for analysis.Results are
 recorded in the "Breastfeeding Follow-up Form." The final stages (after the 1st month
 postpartum), during the house call, 30 ml milk is obtained from the mother with suitable
 methods (Appendix…) and preserved in a sterilized milk collection container, other steps will
 be repeated in the same order. The results of the analysis will be compared with the breast
 milk compositions in the control group. The results of this study are expected to clarify the
 attitudes of healthcare professionals about tandem breastfeeding and to draw attention to
 this issue, thereby providing guidance and encouragement for further studies on the subject..
Inclusion Criteria:

 Being mature newborn (<37 GW) Being a mother who in third trimester The mother's lack of a
 health problem from a metabolic and endocrine perspective related to nutrition Absence of
 diagnosed psychiatric story of the mother Mother's openness to communication and
 cooperation Mother's volunteering to participate in the study Mother being literate Having
 multigravida of the mother Mother's age above 18 years Being a mother non-vegetarian Being
 a mother non-smoker Absence of breast trauma in mother (mastitis, abscess etc.) Mother's
 milk analysis at least a week before without taking any medication Having body mass index
 at normal values (18.5 to 24.9) pre-pregnancy (WHO, 2015).

 Exclusion Criteria:

 Having a condition that obstacle for breastfeeding (craniofacial abnormality such as cleft
 palate, cleft lip, paralysis of facial muscles)