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Jack A, Mullin C, Brown E, Burtner M, Standish KR, Fields A, Rosen-Carole C, Hartman S. Academy of Breastfeeding Medicine Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Period (Revised 2024). Breastfeed Med 2024; 19:575-587. [PMID: 39186728 DOI: 10.1089/bfm.2024.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Background: The Academy of Breastfeeding Medicine revised the 2015 version of this clinical protocol to review the evidence and provide recommendations related to breastfeeding promotion in the prenatal period. Key Information: Promoting and normalizing breastfeeding in the prenatal period can improve breastfeeding outcomes including initiation and duration of breastfeeding. Ideally, prenatal interventions should be a part of a comprehensive longitudinal breastfeeding support program. Recommendations: Clinicians or other health workers should discuss breastfeeding at each prenatal visit. Counseling topics should include the health benefits of breastfeeding versus not breastfeeding, the basics of breastfeeding (e.g., physiology, positioning), what to expect of hospital-based and immediate postpartum breastfeeding support (i.e., Baby-Friendly Ten Steps), and the risks of unnecessary supplementation. Medical, anatomical, and other risk factors for breastfeeding challenges should be identified, and targeted anticipatory guidance should be given. Prenatal counseling should include distribution of structured breastfeeding education at low literacy levels and in the parent's preferred language. Counseling should be culturally sensitive and patient-centered, including family members when appropriate. Prenatal support may integrate various health workers (e.g., medical doctors, midwives, community health workers, lactation consultants, among others) and include various modalities including telecommunication. Enhancing breastfeeding education for prenatal care providers is also imperative. Additional themes related to implementation of recommendations for specific populations are also reviewed.
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Affiliation(s)
- Anna Jack
- Department of Family Medicine, East Ridge Family Medicine, Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, University of Rochester, Rochester, New York, USA
| | - Caroline Mullin
- Department of Family Medicine, Chobanian & Avedisian School of Medicine, Boston Medical Center and East Boston Neighborhood Health Center, Boston University, Boston, Massachusetts, USA
| | - Elizabeth Brown
- Department of Family Medicine, Highland Family Medicine, University of Rochester, Rochester, New York, USA
| | - Michele Burtner
- Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Katherine R Standish
- Department of Family Medicine, Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts, USA
| | - Alecia Fields
- Women's Care of Lake Cumberland, Cumberland Family Medical Center, Somerset, Kentucky, USA
| | - Casey Rosen-Carole
- Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Scott Hartman
- Department of Family Medicine, North Ponds Family Medicine and Maternity Care, Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, University of Rochester, Rochester, New York, USA
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Lam SK, MacWilliams J, Larkin-Baker LC, Szugye H, Furman L. Latching Medical Students onto a Virtual Breastfeeding Elective During the COVID-19 Pandemic. Breastfeed Med 2024; 19:560-567. [PMID: 38655902 DOI: 10.1089/bfm.2024.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Objectives: To describe the implementation of a successful two-week virtual breastfeeding elective for medical students during the COVID-19 pandemic and characterize student demographics, objective knowledge, and perspectives on breastfeeding before and after the elective. Study Design: We adapted the Santa Rosa Kaiser Permanente Family Medicine breastfeeding residency curriculum to create a two-week virtual medical student elective using Kern's six steps of curriculum development and a competency-based education framework. Educational components included self-paced modules, shadowing experiences, and group didactics. Objective knowledge was assessed with multiple-choice tests before and after the elective compared using a paired t-test. Reflective writing pieces were qualitatively analyzed using the six phases of thematic analysis developed by Braun and Clarke. Results: From 2020 to 2023, 40 medical students completed the elective. Breastfeeding knowledge increased significantly from the pre-test 72% (95% CI: 52-92%) to post-test 91% (95% CI: 81-100%) (p < 0.001). Over 90% of students felt that learning objectives were met well or very well and agreed or strongly agreed that the elective increased their knowledge and confidence in providing anticipatory guidance to breastfeeding parents. Similar themes were shared across students' reflective writing pieces, with nearly 30% (n = 23) of the student essays addressing socio-cultural and racial differences in beliefs surrounding breastfeeding. Conclusion: A virtual breastfeeding curriculum for medical students is well-received by stakeholders (patients, lactation consultants, students, etc.) and improves breastfeeding knowledge and confidence. A virtual elective is an innovative and effective way to deliver breastfeeding education and can be used even when institutional breastfeeding or lactation support is unavailable.
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Affiliation(s)
- Suet Kam Lam
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Jessica MacWilliams
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Heidi Szugye
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Lydia Furman
- University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Wood NK, Penders RA, Dyer AM. Breastfeeding Disparities Among Rural Breastfeeding Dyads in High-Income Countries: A Scoping Study. Breastfeed Med 2023; 18:805-821. [PMID: 37883631 DOI: 10.1089/bfm.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background/Objective: Low breastfeeding initiation and duration of exclusivity put rural mothers and infants at risk for morbidity and mortality and significant economic costs. This scoping study aimed to identify determinants of breastfeeding disparities among rural dyads in high-income countries and their modifiable factors. Methods: The Arksey and O'Malley methodological framework was used. A literature review was conducted using PubMed, CINAHL Complete, Embase, and APA PsycInfo databases to identify studies related to rural breastfeeding that met criteria published between 2012 and 2022. Results: Twenty-five studies were included. Rural mothers from high-income countries are more likely to be younger, be unmarried, have lower educational attainment, have lower socioeconomic status, smoke, and have a higher prepregnancy body mass index than their urban counterparts. Rural mothers across White, Black, and Hispanic racial and ethnic groups have significantly lower breastfeeding rates compared to urban mothers. Maternal physiological preparedness, breastfeeding problems, lifestyle choices, support from family, evidence-based practice, workplace support, and policy development and implementation for breastfeeding promotion were identified as modifiable factors. Interventions using technology are an emerging field to overcome rurality. Conclusions: Although breastfeeding disparities are prevalent in rural dyads, the basic challenges mothers face when breastfeeding are universal, despite geographical locations in high-income countries. More specific support needs to be provided for breastfeeding dyads to continue breastfeeding. Resource allocation needs to be improved to increase access to care. Patient-centered technology interventions may decrease breastfeeding barriers in rural areas.
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Affiliation(s)
- Natsuko K Wood
- Washington State University College of Nursing, Nursing & Systems Science Department, Spokane, Washington, USA
| | - Rebecca A Penders
- Washington State Department of Health and Providence Inland Northwest Washington, Spokane, Washington, USA
| | - Ann M Dyer
- Washington State University Health Sciences Library, Spokane, Washington, USA
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Strong G, Gober M, Walker M. Speaking the Same Language: A Call for Standardized Lactation Terminology in the United States. J Hum Lact 2023; 39:121-131. [PMID: 36511175 DOI: 10.1177/08903344221131041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Genae Strong
- Loewenberg College of Nursing, University of Memphis, Memphis, TN, USA
| | - Merrilee Gober
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
| | - Marsha Walker
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
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Conover N, Vanderpool J, Ginsberg J, Kawan M, Spatz DL. Establishing a Breastfeeding Consortium for Clinicians in Pediatric Outpatient Care. MCN Am J Matern Child Nurs 2023; 48:24-29. [PMID: 36136072 DOI: 10.1097/nmc.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Creating a supportive environment for breastfeeding mothers in the primary care setting has been shown to improve breastfeeding rates and duration. An important aspect of establishing a breastfeeding-friendly practice is to engage and educate health care providers. To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families. The COVID-19 pandemic further highlighted the need to share up-to-date education and guidance, and the importance of the role of primary care providers in breastfeeding support. The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families. Although more breastfeeding-specific education is recommended for clinicians, the ABC serves as a model for primary care clinicians to improve their knowledge and provide support for families through education, shared experience, and awareness across many pediatric primary care network sites.
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Impact of the Infant Formula Shortage on Breastfeeding Rates. J Pediatr Health Care 2022; 37:279-286. [PMID: 36528487 DOI: 10.1016/j.pedhc.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aimed to determine the impact of the infant formula shortage on breastfeeding rates. METHOD The sample included infants attending newborn through 2-month visits at a rural pediatric practice. Preshortage data was compared with postshortage data from newborn (pre: n = 302; post: n = 302), 1-month (pre: n = 273, post: n = 259), and 2-month (pre: n = 255; post: n = 234) visits. RESULTS Data analysis using Pearson's χ2 and Mann-Whitney tests found a significant increase in breastfeeding rates postshortage compared with preshortage. Breastfeeding initiation increased by 10.6% compared with preshortage. DISCUSSION Many factors contributed to the significant increase in breastfeeding initiation during the formula shortage. Reports of illnesses associated with the ingestion of infant formula made breastfeeding more appealing. Furthermore, breast milk was readily available, whereas formula was not. Positive breastfeeding experiences during the formula shortage may lead to a sustained increase in breastfeeding.
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Kawan M, Gregory EF, Spatz DL. Improving breastfeeding care & support in a large, urban, pediatric primary care practice. J Pediatr Nurs 2022; 70:e3-e8. [PMID: 36424329 DOI: 10.1016/j.pedn.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND SPECIFIC AIMS Human milk/breastfeeding is the gold standard for infant nutrition. Interventions in pediatric primary care could improve breastfeeding exclusivity and duration. Our specific aims were two-fold: 1) Accurately measure breastfeeding indicators and 2) Implement AAP Breastfeeding-Friendly Pediatric Office Practice Recommendations. MATERIALS AND METHODS In 2018, a single, urban, large primary care pediatric practice initiated a Quality Improvement project to improve breastfeeding outcomes. Stakeholders met to discuss metrics of interest, develop documentation templates, review data capture, and plan interventions to support breastfeeding. Practice based interventions to improve measurement included: piloting documentation templates, incorporation of default templates office-wide, and developing tracking tools for both use of templates and breastfeeding outcomes. Interventions to support breastfeeding occurred simultaneously and included workflow redesign to increase nurse-provided breastfeeding education, partnering with community-based lactation consultants for outpatient support, staff education, and National Breastfeeding Month activities. RESULTS Since initiation of the data analytic tool, breastfeeding data has been analyzed from over 30,000 visits (86% Medicaid-insured, 82% Black race). Currently, 80% of providers use default templates that allow standardized data capture. At first newborn visit, 74% of infants were breastfed. At six months, 36% of infants were breastfed; 23% exclusively. Standardized documentation of infant feeding status improved and has remained consistent. Breastfeeding duration did not significantly improve despite practice interventions. CONCLUSIONS Pediatric primary care measurement tools are feasible and critical to understand breastfeeding continuation. Increased resources and interventions to support breastfeeding in Primary Care are necessary to improve outcomes.
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Affiliation(s)
- Meg Kawan
- Children's Hospital of Philadelphia, United States of America
| | - Emily F Gregory
- Children's Hospital of Philadelphia, United States of America
| | - Diane L Spatz
- Children's Hospital of Philadelphia, United States of America; University of Pennsylvania School of Nursing, United States of America.
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Wu TY, Ford O, Rainville AJ, Bessire R, Yang X, Jackson-Dyer T, Haimout A. Reducing Lactation Support Disparities for a Marginalized Community Through a Policy, Systems, and Environmental Change Approach: A Case Study in Michigan. J Hum Lact 2022; 38:53-60. [PMID: 34971319 DOI: 10.1177/08903344211066836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tsu-Yin Wu
- Eastern Michigan University, Center for Health Disparities Innovations and Studies, Ypsilanti, MI, USA
| | - Olivia Ford
- Eastern Michigan University, School of Health Sciences, Ypsilanti, MI, USA
| | - Alice Jo Rainville
- Eastern Michigan University, School of Health Sciences, Ypsilanti, MI, USA
| | - Rachel Bessire
- Eastern Michigan University, Center for Health Disparities Innovations and Studies, Ypsilanti, MI, USA
| | - Xining Yang
- Department of Geography and Geology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Tameka Jackson-Dyer
- Eastern Michigan University, Center for Health Disparities Innovations and Studies, Ypsilanti, MI, USA
| | - Amaal Haimout
- Wayne County Healthy Communities, Hamtramck, Michigan, MI, USA
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Milinco M, Cattaneo A, Macaluso A, Materassi P, Di Toro N, Ronfani L. Prevalence of breastfeeding in a baby-friendly pediatric practice in Trieste, Italy: follow up to 36 months of age. Int Breastfeed J 2021; 16:93. [PMID: 34906182 PMCID: PMC8672544 DOI: 10.1186/s13006-021-00441-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/25/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A breastfeeding-friendly physician's office that applies the 13 recommendations of the Academy of Breastfeeding Medicine can help increase the exclusivity and duration of breastfeeding. Having already published the results up to five months of age of this intervention in our pediatric practice, we now report on the follow up to 36 months. METHODS A cohort of 252 newborn infants was enrolled with our pediatric office in Trieste, Italy, between 1 January 2016 and 31 December 2016. The office implemented baby-friendly pediatric practices and a biological nurturing approach to the support of breastfeeding. In addition to the services offered by two pediatricians, support was provided by a peer counselor. Data on breastfeeding were collected at periodic healthy child visits up to 36 months of age. The outcome of interest for this follow up was the rate of any breastfeeding, defined as the percentage of infants and children who had received breastmilk in the previous 24 h. RESULTS The rates of any breastfeeding at discharge and at 1, 3 and 5 months (n = 252) were 95.2, 95.8, 89.3 and 86.5%, respectively. At 8, 12, 18, 24 and 36 months of age, the rates of breastfeeding were 70.6% (163/231), 59% (135/229), 35% (78/224), 24.6% (55/224) and 7.2% (16/224), respectively. CONCLUSIONS The rates of any breastfeeding recorded in our pediatric practice up to age 36 months, are much higher than those reported elsewhere in high income countries and are likely to be associated with our baby-friendly and biological nurturing approach.
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Affiliation(s)
- Mariarosa Milinco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | | | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
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