1
|
Berwick M, Louis-Jacques AF. Prenatal Counseling and Preparation for Breastfeeding. Obstet Gynecol Clin North Am 2023; 50:549-565. [PMID: 37500216 DOI: 10.1016/j.ogc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Breastfeeding is the gold standard of infant nutrition and current guidelines suggest exclusive breastfeeding for 6 months, with continued breastfeeding through 24 months or beyond. Obstetric care professionals can encourage and educate their patients about breastfeeding through the prenatal period when many expectant parents make decisions about their infant feeding choices. Education and support should extend through the postpartum period and include parents who may have concerns surrounding medical comorbidities, breast augmentation, or substance use disorders.
Collapse
Affiliation(s)
- Margarita Berwick
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA.
| | - Adetola F Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA
| |
Collapse
|
2
|
MacMillan Uribe AL, DiFilippo KN, Jarnell K, Patterson JA. Evaluation of Commercially Available Infant-feeding Mobile Applications Using App Quality Evaluation Tool. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:604-611. [PMID: 37389498 DOI: 10.1016/j.jneb.2023.05.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Assess the quality of free, commercially available infant-feeding mobile applications (apps) and their appropriateness for audiences with low income and of racial and ethnic diversity using the App Quality Evaluation tool. METHODS Researchers selected apps using an iterative process (n = 6). Health professionals (n = 10) who work with mothers with infants and low income who completed the App Quality Evaluation tool for each app, consisting of 7 domains of app quality. Average domain scores were calculated for each app (> 8 indicates high quality). RESULTS Evaluators highly rated app function and purpose for WebMD Baby (8.0 ± 1.8 and 8.2 ± 0.9, respectively) and Baby Center (8.0 ± 2.1 and 8.0 ± 2.6, respectively). For other apps, no domains were highly rated. No apps were rated highly for appropriateness (range 5.7-7.7) nor provided high-quality infant-feeding information for mothers with low income. Few apps were rated highly appropriate for mothers who are Black or Hispanic. CONCLUSIONS AND IMPLICATIONS Commercially available infant-feeding apps are of limited quality, indicating the need to develop high-quality apps for audiences with low income and Black and Hispanic identities.
Collapse
Affiliation(s)
- Alexandra L MacMillan Uribe
- Healthy Living Program, Texas A&M AgriLife Institute for Advancing Health through Agriculture, College Station, TX
| | - Kristen N DiFilippo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Kelsey Jarnell
- School of Health Studies, College of Health and Human Sciences, Northern Illinois University, DeKalb, IL
| | - Julie A Patterson
- School of Health Studies, College of Health and Human Sciences, Northern Illinois University, DeKalb, IL.
| |
Collapse
|
3
|
Griffin LB, Ding JJ, Has P, Ayala N, Kole-White MB. Lactation Consultation by an International Board Certified Lactation Consultant Improves Breastfeeding Rates for Mothers With Gestational Diabetes Mellitus. J Hum Lact 2022; 38:141-147. [PMID: 34162243 DOI: 10.1177/08903344211018622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with gestational diabetes, breastfeeding decreases the lifetime risk of Type 2 diabetes by half. Lactation consultation has been shown to increase breastfeeding rates in the general population but has not been assessed in a gestational diabetes population. RESEARCH AIMS To determine if (1) a postpartum International Board Certified Lactation Consultant (IBCLC) consultation during delivery hospitalization improved inclusive (any) or exclusive breastfeeding rates at hospital discharge and 3 months postpartum in participants with GDM; and if (2) obstetrical providers' acknowledgement of maternal feeding preference affected the rates of IBCLC consultation for patients. METHODS This was a retrospective, comparative, secondary analysis of a prospective cohort (N = 517) study of women gestational diabetes. Participants who received a IBCLC consultation (n = 386; 74.5%) were compared to those who did not (n = 131; 25.5%). Baseline demographics, antepartum characteristics, neonatal information, mode of infant feeding at hospital discharge and 3 months postpartum, and IBCLC consultation during postpartum hospitalization were measured. RESULTS After adjusting for baseline differences, participants who received an IBCLC consultation were more likely to report any breastfeeding at postpartum discharge (aOR 4.87; 95% CI [2.67, 8.86]) and at 3 months postpartum (aOR 5.39; 95% CI [2.61, 11.16]) compared to participants who did not. However, there was no difference in exclusive breastfeeding rates between those who did and did not receive IBCLC consultation. CONCLUSION Inpatient IBCLC consultation during the immediate postpartum period was associated with improved rates of any breastfeeding in participants with GDM.
Collapse
Affiliation(s)
- Laurie Beth Griffin
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jia Jennifer Ding
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Phinnara Has
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Nina Ayala
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Martha B Kole-White
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
4
|
Path Model Validation of Breastfeeding Intention Among Pregnant Women. J Obstet Gynecol Neonatal Nurs 2021; 50:167-180. [PMID: 33465339 DOI: 10.1016/j.jogn.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To validate a blended health belief model and integrated behavioral model of selected modifiable psychosocial constructs during pregnancy to seek the best-fit path model for breastfeeding intention. DESIGN A nonexperimental, cross-sectional study. SETTING A virtual online market research sample aggregator. PARTICIPANTS Women (N = 300) between 18 and 45 years of age in their second or third trimesters of pregnancy participated in the study in February 2018. METHODS Based on the health belief model and the integrated behavioral model, we proposed a theoretical framework, including self-efficacy for breastfeeding, knowledge, perceived benefits, perceived barriers, attitude toward breastfeeding, patient-provider interaction, and motivation to breastfeed, to predict breastfeeding intention. We administered a 98-item questionnaire modified from preexisting instruments. We conducted descriptive, bivariate, and regression analyses to help with the formation of the path model. RESULTS The best-fit path model with all significant paths and effect directions showed that intention to breastfeed is directly influenced by motivation to breastfeed, attitudes toward breastfeeding, and self-efficacy for breastfeeding, which together accounted for 56% (R2) of the variance in intention. We also identified indirect effects from knowledge about breastfeeding, patient-provider interaction, perceived benefits, and perceived barriers and their interrelationships with effect directions. CONCLUSION Through our findings, we contribute to the emerging body of evidence that shows the significant variables and their effect directions for breastfeeding intention. Incorporating these findings may provide support and evidence for clinical and community interventions focusing on modifiable psychosocial constructs during pregnancy to promote breastfeeding and further investigations using health behavior theories.
Collapse
|
5
|
Stuebe A. Leveraging the Magic of Human Milk. Breastfeed Med 2020; 15:183-184. [PMID: 32073895 DOI: 10.1089/bfm.2020.29148.ams] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
6
|
Radoff K, Forman R. Lactation Education for Resident Obstetricians: Promoting Breastfeeding Advocates for the Future. J Midwifery Womens Health 2019; 64:754-762. [PMID: 31608544 DOI: 10.1111/jmwh.13037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022]
Abstract
Obstetrics and gynecology residency training programs are historically lacking in breastfeeding education and advocacy. Healthy People 2020 supports interventions that promote breastfeeding as a primary care strategy with significant health benefits to the newborn and woman. Midwives are well poised to engage obstetrics and gynecology residents in lactation education. A few educational interventions have been described in the literature to increase knowledge, confidence, and behavior related to lactation among residents. This article describes a breastfeeding education curriculum developed by midwifery faculty at Boston University School of Medicine. The project included 3 lectures and a simulation center workshop covering topics including lactogenesis, prenatal, intrapartum, and postpartum interventions that promote or limit lactation, hands-on latch assistance, hand expression, use of breast pumps and storage of human milk, and common disorders of lactation. Postintervention evaluations demonstrated improvements in knowledge and confidence. Providing breastfeeding education to resident physicians may be an intervention to promote patient breastfeeding education and support and close the gap of disparities in breastfeeding rates.
Collapse
Affiliation(s)
- Kari Radoff
- Boston University School of Medicine, Boston, Massachusetts
| | - Rosha Forman
- Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
7
|
Ma S, Hu S, Liang H, Xiao Y, Tan H. Metabolic effects of breastfeed in women with prior gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Res Rev 2019; 35:e3108. [PMID: 30513131 PMCID: PMC6590118 DOI: 10.1002/dmrr.3108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
This study was undertaken to provide comprehensive analyses of current research developments in the field of breastfeed (BF) and metabolic-related outcomes among women with prior gestational diabetes mellitus (GDM). Database PubMed, Embase, BIOSIS Previews, Web of Science, and Cochrane Library were searched through December 3, 2017. Odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were pooled by random-effects model using Stata version 12.0. Twenty-three observational studies were included in quantitative synthesis. Reduced possibility of progression to type 2 diabetes mellitus (T2DM; OR = 0.79; 95% CI, 0.68-0.92) and pre-DM (OR = 0.66; 95% CI, 0.51-0.86) were found among women with longer BF of any intensity after GDM pregnancy. The positive effect of longer BF on progression to T2DM gradually became prominent with the extension of follow-up period. Compared with women with shorter BF, those with longer BF manifested more favourable metabolic parameters, including significant lower body mass index, fasting glucose, triglyceride, and higher insulin sensitivity index. The findings support that BF may play an important role in protection against the development of T2DM-related outcomes in midlife of women with prior GDM. However, further studies are needed to reveal the etiological mechanism.
Collapse
Affiliation(s)
- Shujuan Ma
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Shimin Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Huiling Liang
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Yanni Xiao
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| |
Collapse
|
8
|
Ramos MM, Sebastian RA, Sebesta E, McConnell AE, McKinney CR. Missed Opportunities in the Outpatient Pediatric Setting to Support Breastfeeding: Results From a Mixed-Methods Study. J Pediatr Health Care 2019; 33:64-71. [PMID: 30217618 DOI: 10.1016/j.pedhc.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Outpatient pediatric providers play a crucial role in the promotion of breastfeeding. We conducted a mixed methods study to measure provider knowledge, attitudes, and current practices around breastfeeding counseling. METHOD In New Mexico in 2016 and 2017, we conducted a knowledge, attitudes, and practice survey of outpatient pediatric providers (i.e., nurse practitioners, physicians, and physician assistants) and conducted focus groups with outpatient pediatric providers. RESULTS Seventy-seven providers responded to the survey, and 17 participated in three focus groups. Fewer than half of providers surveyed reported asking how long mothers plan to breastfeed at initial well-baby examinations. One quarter of participants (28.2%) erroneously reported that hepatitis C was an absolute contraindication to breastfeeding. Just half of respondents had received continuing education within the past 3 years about managing common breastfeeding problems. DISCUSSION We identified missed opportunities for outpatient pediatric providers to support breastfeeding and a need for continuing provider education.
Collapse
Affiliation(s)
- Mary M Ramos
- Mary M. Ramos, Assistant Professor, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM..
| | - Rachel A Sebastian
- Rachel A. Sebastian, Medical Sociologist, Child Policy Research Consulting, LLC, Fort Wright, KY
| | - Emilie Sebesta
- Emilie Sebesta, Professor, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Adrienne E McConnell
- Adrienne E. McConnell, Health Education Consultant, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Courtney R McKinney
- Courtney R. McKinney, Program Manager, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| |
Collapse
|
9
|
Kellams AL, Gurka KK, Hornsby PP, Drake E, Conaway MR. A Randomized Trial of Prenatal Video Education to Improve Breastfeeding Among Low-Income Women. Breastfeed Med 2018; 13:666-673. [PMID: 30351169 DOI: 10.1089/bfm.2018.0115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Many women initiate breastfeeding but do not meet their duration goals, and low-income women initiate and continue breastfeeding at lower rates than their counterparts. One-on-one counseling is associated with increased breastfeeding but requires significant resources. In contrast, video education, which requires fewer resources and is effective in other health care settings, such as vaccine uptake, has gone untested for prolonging breastfeeding duration among low-income women. Objective: To determine whether use of an educational breastfeeding video shown individually to low-income pregnant women in the prenatal clinic would prolong duration of any and exclusive breastfeeding. Methods: A multicenter, randomized, controlled trial was conducted in four prenatal clinics. Low-income pregnant women were randomized to view the intervention (breastfeeding education) or control (prenatal nutrition) video in the third trimester and interviewed by telephone at 1, 3, and 6 months postpartum about infant feeding practices. Kaplan-Meier survival curves with log-rank tests and Cox proportional hazards regression were utilized to compare groups. Results: Of the 816 eligible women approached, 64% participated: 263 assigned to the intervention, and 259 assigned to the control. Six-month data were obtained for 211 (80%) and 220 (85%) women, respectively. Rate of breastfeeding cessation did not differ by group (hazard ratios; HR = 1.00, 95% confidence interval [CI]: 0.81-1.24 and HR = 0.93, 95% CI: 0.76-1.14, for any and exclusive breastfeeding, respectively). Conclusion: A single viewing of a breastfeeding education video shown in the prenatal clinic did not impact breastfeeding duration or exclusivity among low-income women in this study. Although not sufficient alone, educational videos may be useful as one component of a comprehensive program to promote breastfeeding.
Collapse
Affiliation(s)
- Ann L Kellams
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Kelly K Gurka
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Paige P Hornsby
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Emily Drake
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Mark R Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
10
|
Lee E, Jackson J. Breast is BEST: Increasing Health-Care Provider Knowledge and Confidence. J Dr Nurs Pract 2018; 11:132-138. [PMID: 32745020 DOI: 10.1891/2380-9418.11.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breastfeeding is recognized as the ideal source of nutrition for infants. However, several barriers to successful breastfeeding have been identified. Possibly one of the most significant barriers is the lack of health-care provider-related support and promotion of breastfeeding. OBJECTIVE The purpose of this study was to recognize the barriers to breastfeeding, ways health-care providers can assist patients in overcoming those barriers, and increase breastfeeding knowledge and confidence of health-care providers to better promote and manage breastfeeding clients. METHODS Study participants included: physicians, advanced practice nurses, and nurses. The American Academy of Pediatrics (AAP) Breastfeeding Residency Curriculum was utilized in the study, and participants were also educated on and encouraged to apply ACOG's Perinatal Practice Guidelines. RESULTS There was an overall increase of 19.2% in health-care provider knowledge scores and a 23% increase in confidence scores. There was also a 15.6% increase in documentation of early prenatal breastfeeding counseling. CONCLUSIONS The results and significance of the study provide evidence that once health-care providers are knowledgeable and confident in promoting breastfeeding, clients will be better equipped to successfully breastfeed. IMPLICATIONS FOR NURSING Breastfeeding success rates among mothers can be greatly improved through active support from health-care providers.
Collapse
Affiliation(s)
- Emily Lee
- Tennessee Technological University, Cookeville, Tennessee
| | - Joanie Jackson
- Tennessee Technological University, Cookeville, Tennessee
| |
Collapse
|
11
|
Ross-Cowdery M, Lewis CA, Papic M, Corbelli J, Schwarz EB. Counseling About the Maternal Health Benefits of Breastfeeding and Mothers' Intentions to Breastfeed. Matern Child Health J 2018; 21:234-241. [PMID: 27443655 DOI: 10.1007/s10995-016-2130-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives To evaluate the impact of counseling regarding the maternal health effects of lactation on pregnant women's intentions to breastfeed. Methods Women seeking prenatal care at an urban university hospital completed surveys before and after receiving a 5-min counseling intervention regarding the maternal health effects of breastfeeding. The counseling was delivered by student volunteers using a script and one-page infographic. Participants were asked the likelihood that breastfeeding affects maternal risk of multiple chronic conditions using 7-point Likert scales. We compared pre/post changes in individual item responses and a summary score of knowledge of the maternal health benefits of lactation (MHBL) using paired t tests. Multivariable logistic regression was used to examine the impact of increases in knowledge of MHBL on participants' intentions to breastfeed. Results The average age of the 65 participants was 24 ± 6 years. Most (72 %) were African-American and few (9 %) had college degrees. Half (50 %) had previously given birth, but few (21 %) had previously breastfed. Before counseling, few were aware of any benefits of lactation for maternal health. After counseling, knowledge of MHBL increased (mean knowledge score improved from 19/35 to 26/35, p < 0.001). Improvement in MHBL knowledge score was associated with increased intention to try breastfeeding (aOR 1.20, 95 % CI 1.02-1.42), of wanting to breastfeed (aOR 1.45, 95 % CI 1.13-1.86), and feeling that breastfeeding is important (aOR 1.21, 95 % CI 1.03-1.42). Conclusions for Practice Brief structured counseling regarding the effects of lactation on maternal health can increase awareness of the maternal health benefits of breastfeeding and strengthen pregnant women's intentions to breastfeed.
Collapse
Affiliation(s)
| | - Carrie A Lewis
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Melissa Papic
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Eleanor Bimla Schwarz
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA. .,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. .,Division of General Internal Medicine, Department of Medicine, University of California, Davis, 4150 V Street, PSSB 2400 [room 2506], Sacramento, CA, 95817, USA.
| |
Collapse
|
12
|
Abstract
BACKGROUND Although breastfeeding is associated with proven benefits to both mother and child, there are many factors that influence a mother's decision to breastfeed. Pregnancy intentionality at the time of conception is associated with postpartum maternal behavior including breastfeeding. Research aim: We sought to understand how maternal and paternal pregnancy intentions were associated with breastfeeding initiation and duration in a nationally representative sample. METHODS We used a cross-sectional, retrospective study of the CDC National Survey of Family Growth data to examine the link between pregnancy intentionality and breastfeeding initiation and duration among women ages 15 to 44 years. RESULTS We found that whereas the mother's intention to have a child was a factor in how long she breastfed, the paternal intention to have a child predicted whether the mother breastfed at all. Additionally, Hispanic mothers were most likely to breastfeed and breastfed the longest of any other group. Age and education were also positive predictors of ever breastfeeding. CONCLUSION Understanding the father's and mother's attitudes toward the pregnancy and influence on breastfeeding intention is important for intervention planning.
Collapse
Affiliation(s)
- Shimrit Keddem
- 1 Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.,2 VISN 4 Center for the Evaluation of Patient Aligned Care Teams, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rosemary Frasso
- 3 Master of Public Health Program, College of Population Health, Jefferson University, Philadelphia, PA, USA
| | - Melissa Dichter
- 4 Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,5 Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra Hanlon
- 6 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
13
|
Burns W, Rovnyak V, Friedman C, Drake E, Hornsby P, Kellams A. BAP: Testing of a Breastfeeding History Questionnaire to Identify Mothers at Risk for Postpartum Formula Supplementation. CLINICAL LACTATION 2018. [DOI: 10.1891/2158-0782.9.1.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The objective of this study was to test a breastfeeding history questionnaire to predict inhospital formula supplementation.Methods: A breastfeeding questionnaire named BAP, an abbreviation based on three questions, was conceptualized and implemented in clinical practice. Primary outcome was formula supplementation during the postpartum hospital stay.Results: Multiparous women with BAP scores of 1 or less were over four times more likely to use formula during the postpartum hospital stay than women with BAP scores of 2 or greater (RR = 4.35, 95% CI [2.47, 7.65]; p < .001). Additionally, multiparous mothers with BAP scores of 1 or less were more likely to use formula than primiparous mothers (RR = 1.93, 95% CI [1.47, 2.52]; p < .001). The adjusted odds of formula use were eight times greater for women with the lower BAP score (aOR 8.04, 95% CI [3.10, 20.86]; p < .001).Conclusions: The BAP tool can be used to identify multiparous women most at risk for early formula use, thereby allowing targeted referral to breastfeeding support services.
Collapse
|
14
|
Johnson AM, Kirk R, Rooks AJ, Muzik M. Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers. Matern Child Health J 2017; 20:92-102. [PMID: 27449776 PMCID: PMC5290044 DOI: 10.1007/s10995-016-2085-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives To explore African American women's breastfeeding thoughts, attitudes, and experiences with healthcare professionals and subsequent influences on their breastfeeding interest and behavior. Insight was also sought about the most effective practices to provide breastfeeding support to African American women. Methods Thirty-eight pregnant or lactating African American women and racially diverse health professionals were recruited and participated in one of six membership specific focus groups in the metro Detroit area. An experienced focus group facilitator who was African American woman served as the primary group facilitator, using a semi-structured guide to discussions. Focus groups explored perceptions of personal and professional roles and behaviors that support African American women's breastfeeding behavior. Discussions were digitally recorded and audiotapes were transcribed. Thematic content analysis was conducted in combination with a review of field notes. Results Participants generally agreed that breastfeeding is the healthier feeding method but perceived that healthcare providers were not always fully supportive and sometimes discouraged breastfeeding. Non-breastfeeding mothers often expressed distrust of the information and recommendations given by healthcare providers and relied more on peers and relatives. Health professionals lacked information and skills to successfully engage African American women around breastfeeding. Conclusions for Practice Breastfeeding initiation and duration among African American mothers may increase when postpartum breastfeeding interventions address social and cultural challenges and when hospital breastfeeding support with the right professional lactation support, is void of unconscious bias and bridges hospital, community, peers, and family support. Professional lactation training for healthcare professionals who are in contact with expectant and new mothers and an increase in the number of IBCLC of color could help.
Collapse
Affiliation(s)
- Angela M Johnson
- Program for Multicultural Health, Department of Community Programs and Services, University of Michigan Health System, 2025 Traverwood Dr., Ann Arbor, MI, 48105-2197, USA
| | - Rosalind Kirk
- Women and Infants Mental Health Program, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Alfreda Jordan Rooks
- Program for Multicultural Health, Department of Community Programs and Services, University of Michigan Health System, 2025 Traverwood Dr., Ann Arbor, MI, 48105-2197, USA
| | - Maria Muzik
- Women and Infants Mental Health Program, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
15
|
Louis-Jacques A, Deubel TF, Taylor M, Stuebe AM. Racial and ethnic disparities in U.S. breastfeeding and implications for maternal and child health outcomes. Semin Perinatol 2017. [PMID: 28624126 DOI: 10.1053/j.semperi.2017.04.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Marked racial and ethnic disparities exist in infant feeding in the United States. Based on a review of recent literature, this article examines current discrepancies between the 2020 Healthy People breastfeeding goals and current breastfeeding rates among women from different ethnic groups in the United States. We discuss maternal and child health outcomes associated with breastfeeding, and we review potential causes of racial and ethnic disparities in breastfeeding outcomes in the United States, especially among non-Hispanic Black, American Indian/Alaska Native, and Hispanic/Latina populations. We conclude with an overview of best practices in interventions aimed to increase U.S. breastfeeding rates, such as adoption of the baby friendly hospital initiative (BHFI) and programs that utilize peer counseling strategies to increase breastfeeding promotion and support.
Collapse
Affiliation(s)
- Adetola Louis-Jacques
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33579.
| | - Tara F Deubel
- Department of Anthropology, University of South Florida, Tampa, FL
| | - Melina Taylor
- Department of Anthropology, University of South Florida, Tampa, FL; College of Public Health, University of South Florida, Tampa, FL
| | - Alison M Stuebe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, NC
| |
Collapse
|
16
|
Chen L, Crockett AH, Covington-Kolb S, Heberlein E, Zhang L, Sun X. Centering and Racial Disparities (CRADLE study): rationale and design of a randomized controlled trial of centeringpregnancy and birth outcomes. BMC Pregnancy Childbirth 2017; 17:118. [PMID: 28403832 PMCID: PMC5390374 DOI: 10.1186/s12884-017-1295-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/25/2017] [Indexed: 11/25/2022] Open
Abstract
Background In the United States, preterm birth (PTB) before 37 weeks gestational age occurs at an unacceptably high rate, and large racial disparities persist. To date, medical and public health interventions have achieved limited success in reducing rates of PTB. Innovative changes in healthcare delivery are needed to improve pregnancy outcomes. One such model is CenteringPregnancy group prenatal care (GPNC), in which individual physical assessments are combined with facilitated group education and social support. Most existing studies in the literature on GPNC are observational. Although the results are promising, they are not powered to detect differences in PTB, do not address the racial disparity in PTB, and do not include measures of hypothesized mediators that are theoretically based and validated. The aims of this randomized controlled trial (RCT) are to compare birth outcomes as well as maternal behavioral and psychosocial outcomes by race among pregnant women who participate in GPNC to their counterparts in individual prenatal care (IPNC) and to investigate whether improving women’s behavioral and psychosocial outcomes will explain the potential benefits of GPNC on birth outcomes and racial disparities. Methods/design This is a single site RCT study at Greenville Health System in South Carolina. Women are eligible if they are between 14–45 years old and enter prenatal care before 20 6/7 weeks of gestational age. Eligible, consenting women will be randomized 1:1 into GPNC group or IPNC group, stratified by race. Women allocated to GPNC will attend 2-h group prenatal care sessions according to the standard curriculum provided by the Centering Healthcare Institute, with other women due to deliver in the same month. Women allocated to IPNC will attend standard, traditional individual prenatal care according to standard clinical guidelines. Patients in both groups will be followed up until 12 weeks postpartum. Discussion Findings from this project will provide rigorous scientific evidence on the role of GPNC in reducing the rate of PTB, and specifically in reducing racial disparities in PTB. Establishing the improved effect of GPNC on pregnancy and birth outcomes can change the way healthcare is delivered, particularly with populations with higher rates of PTB. Trial registration NCT02640638 Date Registered: 12/20/2015.
Collapse
Affiliation(s)
- Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA.
| | - Amy H Crockett
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC, 29605, USA
| | - Sarah Covington-Kolb
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC, 29605, USA
| | - Emily Heberlein
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, 30303, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Xiaoqian Sun
- Department of Mathematical Sciences, Clemson University, Clemson, SC, 29634, USA
| |
Collapse
|
17
|
Holland CL, Nkumsah MA, Morrison P, Tarr JA, Rubio D, Rodriguez KL, Kraemer KL, Day N, Arnold RM, Chang JC. "Anything above marijuana takes priority": Obstetric providers' attitudes and counseling strategies regarding perinatal marijuana use. PATIENT EDUCATION AND COUNSELING 2016; 99:1446-51. [PMID: 27316326 PMCID: PMC5007170 DOI: 10.1016/j.pec.2016.06.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/19/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe obstetric provider attitudes, beliefs, approaches, concerns, and needs about addressing perinatal marijuana use with their pregnant patients. METHODS We conducted individual semi-structured interviews with obstetric providers and asked them to describe their thoughts and experiences about addressing perinatal marijuana use. Interviews were transcribed verbatim, coded and reviewed to identify themes. RESULTS Fifty-one providers participated in semi-structured interviews. Providers admitted they were not familiar with identified risks of marijuana use during pregnancy, they perceived marijuana was not as dangerous as other illicit drugs, and they believed patients did not view marijuana as a drug. Most provider counseling strategies focused on marijuana's status as an illegal drug and the risk of child protective services being contacted if patients tested positive at time of delivery. CONCLUSIONS When counseling about perinatal marijuana use, obstetric providers focus more on legal issues than on health risks. They describe needing more information regarding medical consequences of marijuana use during pregnancy. PRACTICE IMPLICATIONS Provider training should include information about potential consequences of perinatal marijuana use and address ways to improve obstetric providers' counseling. Future studies should assess changes in providers' attitudes as more states consider the legalization of marijuana.
Collapse
Affiliation(s)
- Cynthia L Holland
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Michelle Abena Nkumsah
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA; University of Pittsburgh Dietrich School of Arts and Sciences, 139 University Pl, Pittsburgh PA 15260, USA
| | - Penelope Morrison
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Jill A Tarr
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Doris Rubio
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA; Clinical and Translational Science Institute University of Pittsburgh, 200 Meyran Ave, Pittsburgh PA 15213, USA
| | - Keri L Rodriguez
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Health Equity Research & Promotion (CHERP) Veterans Affairs Pittsburgh Healthcare System University Drive 151C, Pittsburgh PA 15240, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA; Clinical and Translational Science Institute University of Pittsburgh, 200 Meyran Ave, Pittsburgh PA 15213, USA
| | - Nancy Day
- Department of Psychiatry, University of Pittsburgh, 3800 O'Hara Street, Pittsburgh PA 15213, USA
| | - Robert M Arnold
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA; Section of Palliative Care and Medical Ethics, Institute to Enhance Palliative Care; Institute for Doctor-Patient Communication UPMC Montefiore 932W, 200 Lothrop St. Pittsburgh PA, 15213, USA
| | - Judy C Chang
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA; Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA.
| |
Collapse
|
18
|
Abstract
Obstetricians and other obstetric providers play a critical role in promoting, protecting, and supporting breastfeeding. Most obstetricians agree that they have a role in breastfeeding support and promotion; however, they often feel unprepared to do so. Breastfeeding support from clinicians is a highly modifiable barrier to breastfeeding success and physician education in breastfeeding medicine is vital to the provision of optimal obstetric care. Obstetricians can easily utilize numerous existing online and print resources to improve their own knowledge, making them an invaluable resource to their patients.
Collapse
|
19
|
Shen Y, Rudesill R. Impact of an Educational Intervention on Breastfeeding Counseling Behavior of OB/GYN Residents. Breastfeed Med 2016; 11:286-292. [PMID: 27135963 DOI: 10.1089/bfm.2015.0191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Breastfeeding counseling has been shown to increase the initiation and duration of breastfeeding. The American Congress of Obstetricians and Gynecologists calls for all healthcare workers to educate and encourage women to choose breastfeeding. Despite these recommendations, the reported incidence of prenatal breastfeeding discussions varies widely. Lack of physician education has been speculated to be one of the contributing factors. OBJECTIVE To assess the impact of a breastfeeding educational intervention on the knowledge and counseling behaviors of OB/GYN resident physicians. STUDY DESIGN Resident physicians in a university-based OB/GYN program were given two lectures on the benefits of breastfeeding and common lactation issues. The residents completed a knowledge test before and after the educational intervention. Resident behaviors were assessed through patient surveys after the initial prenatal visit (n = 79 and n = 81 before and after the educational sessions, respectively). The responses were then analyzed by comparing binomial proportions before and after the intervention. RESULTS Patient surveys showed that the educational intervention resulted in statistically significant increases in the rate of general discussion from 62% to 79% (p = 0.017) and discussion of breast changes that occur during pregnancy from 41% to 57% (p = 0.037). There was a positive trend for breastfeeding promotion from 58% to 72% (p = 0.08) and for breast exams from 42% to 56% (p = 0.08). The median score on resident's knowledge assessment test increased marginally from 20 to 20.5 out of 28 questions after the educational intervention. CONCLUSION Our study showed that a brief educational intervention on breastfeeding had a meaningful impact on OB/GYN resident physician counseling behavior.
Collapse
Affiliation(s)
- Ye Shen
- The results of this research were presented as a poster presentation at the Academy of Breastfeeding Medicine 20th Annual International Meeting, Los Angeles, California, October 16-18, 2015.,Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center , Columbus, Ohio
| | - Rebecca Rudesill
- The results of this research were presented as a poster presentation at the Academy of Breastfeeding Medicine 20th Annual International Meeting, Los Angeles, California, October 16-18, 2015.,Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center , Columbus, Ohio
| |
Collapse
|
20
|
Colicchia LC, Holland CL, Tarr JA, Rubio DM, Rothenberger SD, Chang JC. Patient-Health Care Provider Conversations About Prenatal Genetic Screening: Recommendation or Personal Choice. Obstet Gynecol 2016; 127:1145-1152. [PMID: 27159763 PMCID: PMC4879044 DOI: 10.1097/aog.0000000000001433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess how obstetric health care providers counsel patients regarding prenatal genetic screening and how these conversations influence patients' screening decisions. METHODS This cohort study analyzed transcripts and audio recordings of 210 first prenatal visits collected as part of a larger study on patient-provider communication. Conversations were coded in an iterative process to determine compliance with American College of Obstetricians and Gynecologists (College) prenatal genetic screening recommendations and to identify recurrent themes. χ, nonparametric tests, and logistic regression were used to determine the effects of discussion elements on screening decisions. Qualitative analysis was performed for genetic screening content. RESULTS The study included 210 patients and 45 health care providers. Health care providers offered genetic screening at 90% of visits; 78% of women chose genetic screening. Few conversations (1.5%) included all College-recommended topics. Inclusion of College-recommended topics did not affect women's screening choices. Conversations about screening for fetal aneuploidy lasted 1.5 minutes on average (range 0.12-7.05 minutes). Recurrent themes identified included clarifying that screening results are not diagnostic (51% of conversations), emphasizing that screening is a personal choice (45% of conversations), and discussing how a woman might use genetic screening results to guide decisions about diagnostic testing or termination (37% of conversations). Health care providers described screening results as "high or low risk" in 67% of conversations discussing risk and quantitatively (ie, 1 in 100 [1%]) in 33%. CONCLUSION Although the majority of patients were offered and underwent screening, most health care providers' counseling did not adhere to College recommendations.
Collapse
Affiliation(s)
- Laura C Colicchia
- University of Pittsburgh Medical Center, Magee-Womens Research Institute, the University of Pittsburgh Center for Research in Health Care Data Center, and the Departments of Obstetrics, Gynecology, and Reproductive Science and Internal Medicine and the Center for Research in Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
21
|
Sriraman NK, Kellams A. Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals. J Womens Health (Larchmt) 2016; 25:714-22. [PMID: 27111125 DOI: 10.1089/jwh.2014.5059] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite recognized health benefits for both mothers and infants, significant disparities still exist in the rates of breastfeeding in the United States. Major organizations representing the health of women and children (including the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics [AAP], American Congress of Obstetrics and Gynecology [ACOG], American Academy of Family Physicians [AAFP], United Nations International Children's Emergency Fund (UNICEF), the World Health Organization [WHO], and the United States Public Health Service [PHS]) recommend exclusive breastfeeding, but statistics show that although many women initiate breastfeeding, few meet the recommended goals for duration and exclusivity. This article reviews the evidence related to barriers (prenatal, medical, societal, hospital, and sociocultural) that many mothers face, and explore the known barriers and the impact they have on a woman's ability to breastfeed her infant. Strategies will be discussed to address (and potentially overcome) some of the most common barriers women face along with a list of resources that can be useful in this effort. Gaps in care and areas that need further research will be noted. This article is targeted toward physicians and other healthcare providers who work with women and who can assist with and advocate for the removal of barriers and thereby improve the health of women and children by increasing the rates of breastfeeding initiation, duration, and exclusivity in the United States.
Collapse
Affiliation(s)
- Natasha K Sriraman
- Division of General Academic Pediatrics, Children's Hospital of the King's Daughters/Eastern Virginia Medical School , Norfolk, Virginia.,Well Newborn and Breastfeeding Medicine Services, Department of Pediatrics, University of Virginia , Charlottesville, Virginia
| | - Ann Kellams
- Division of General Academic Pediatrics, Children's Hospital of the King's Daughters/Eastern Virginia Medical School , Norfolk, Virginia.,Well Newborn and Breastfeeding Medicine Services, Department of Pediatrics, University of Virginia , Charlottesville, Virginia
| |
Collapse
|
22
|
Abstract
Group prenatal care is an emerging trend in obstetrics, and for medically low-risk women has been shown to result in lower rates of preterm birth, higher rates of breastfeeding, and higher rates of participation in postpartum family planning. Significant cost savings to the health care system are seen when the lower rates of preterm birth and neonatal intensive care unit admissions are considered. More research is needed about patients' health outcomes as well as the economic and workforce implications to outpatient obstetric practices before widely transitioning prenatal care into group settings.
Collapse
|
23
|
Kellams AL, Gurka KK, Hornsby PP, Drake E, Riffon M, Gellerson D, Gulati G, Coleman V. The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population. J Hum Lact 2016; 32:152-9. [PMID: 26289058 DOI: 10.1177/0890334415599402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend prenatal education to improve breastfeeding rates; however, effective educational interventions targeted at low-income, minority populations are needed as they remain less likely to breastfeed. OBJECTIVE To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population. METHODS A total of 522 low-income women were randomized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise. Using multivariable analyses, breastfeeding initiation rates and exclusivity during the hospital stay were compared. RESULTS Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups (P = .87). CONCLUSION This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.
Collapse
Affiliation(s)
- Ann L Kellams
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Kelly K Gurka
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA
| | - Paige P Hornsby
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Emily Drake
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Mark Riffon
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | | | - Gauri Gulati
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Valerie Coleman
- Institute of Women's Health, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
24
|
Abstract
Objectives: Identify, synthesize, and critically review research on common barriers to successful breastfeeding and ways healthcare providers can assist patients in overcoming the barriers.Methods: A search of databases and citations for evidence-based research published from 2001 to 2015 was conducted. Forty-nine articles were reviewed with 22 articles being discussed.Results: Three major themes were identified: (a) characteristics of breastfeeding education in the prenatal setting, (b) primary care interventions to promote breastfeeding, and (c) healthcare provider education on breastfeeding.Conclusions: Findings of this review collectively suggest the need to increase breastfeeding rates among women in the United States. To achieve this, there is great significance placed on healthcare providers implementing interventions to promote breastfeeding, which subsequently requires improving healthcare provider knowledge and self-confidence on breastfeeding.
Collapse
|
25
|
Demirci JR, Cohen SM, Parker M, Holmes A, Bogen DL. Access, Use, and Preferences for Technology-Based Perinatal and Breastfeeding Support Among Childbearing Women. J Perinat Educ 2016; 25:29-36. [PMID: 26848248 PMCID: PMC4719111 DOI: 10.1891/1058-1243.25.1.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We surveyed 146 postpartum women who birthed at 34-37 6/7 weeks of gestation and intended to breastfeed about their use of and preferences regarding technology to obtain perinatal and breastfeeding support. Most participants owned smartphones and used technology during pregnancy to track pregnancy data, follow fetal development, address pregnancy concerns, and obtain breastfeeding information. Internet, e-mail, apps, and multiplatform resources were the most popular technologies used and preferred. Demographic differences existed in mobile technology access and preferences for different technologies. In terms of technology-based breastfeeding support, women wanted encouragement, anticipatory guidance, and information about milk production. A nuanced understanding of the technology childbearing women use and desire has the potential to impact clinical care and inform perinatal support interventions.
Collapse
|
26
|
Garner CD, Ratcliff SL, Thornburg LL, Wethington E, Howard CR, Rasmussen KM. Discontinuity of Breastfeeding Care: "There's No Captain of the Ship". Breastfeed Med 2016; 11:32-9. [PMID: 26566010 PMCID: PMC4742991 DOI: 10.1089/bfm.2015.0142] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breastfeeding rates in the United States are suboptimal. Health professionals (HPs) have a unique opportunity to support breastfeeding because of the frequency and timing of their visits with mothers and infants as well as their call by professional organizations to do so. The objective of this study was to understand HPs' perceived roles and experiences with providing breastfeeding-related care. MATERIALS AND METHODS In-depth qualitative interviews were conducted with 34 HPs (obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. Interviews were audio-recorded, transcribed, and verified for accuracy; content analysis was used to identify themes using a grounded theory approach. RESULTS The overarching theme was discontinuity in breastfeeding care across the continuum. Most HPs relied on other HPs to provide breastfeeding care, which resulted from and contributed to problematic gaps in care that were reported. A minority of HPs attempted to bridge gaps in breastfeeding care or improve continuity. Contributing to the discontinuity were a lack of time, lack of skills, inconsistent messages, and low communication across stages of care. HPs were unsure whether their help was effective and whether required follow-up was completed. CONCLUSIONS Despite HPs' recognition of breastfeeding as the best choice for infant feeding, breastfeeding care may be disjointed and a barrier to achieving breastfeeding recommendations. These problems should be investigated and systemically addressed in future research so that maternal-infant dyad breastfeeding care can be improved.
Collapse
Affiliation(s)
- Christine D Garner
- 1 Division of Nutritional Sciences, Cornell University , Ithaca, New York
| | | | - Loralei L Thornburg
- 2 Department of Obstetrics and Gynecology, University of Rochester , Rochester, New York
| | - Elaine Wethington
- 3 Department of Human Development, Cornell University , Ithaca, New York
| | - Cynthia R Howard
- 4 Department of Pediatrics, University of Rochester , Rochester, New York
| | | |
Collapse
|
27
|
Balyakina E, Fulda KG, Franks SF, Cardarelli KM, Hinkle K. Association Between Healthcare Provider Type and Intent to Breastfeed Among Expectant Mothers. Matern Child Health J 2015; 20:993-1000. [DOI: 10.1007/s10995-015-1884-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Rosen-Carole C, Hartman S. ABM Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Setting, Revision 2015. Breastfeed Med 2015; 10:451-7. [PMID: 26651541 PMCID: PMC4685902 DOI: 10.1089/bfm.2015.29016.ros] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Collapse
Affiliation(s)
- Casey Rosen-Carole
- Department of General Pediatrics, University of Rochester, Rochester, New York
| | - Scott Hartman
- Department of Family Medicine, University of Rochester, Rochester, New York
| |
Collapse
|
29
|
Abstract
This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.
Collapse
Affiliation(s)
- Katherine M. Jones
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
- Department of Psychology, American University, Washington, D.C
| | - Michael L. Power
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
| | - John T. Queenan
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, D.C
| | - Jay Schulkin
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
| |
Collapse
|
30
|
Sims AM, Long SA, Tender JAF, Young MA. Surveying the knowledge, attitudes, and practices of District of Columbia ACOG members related to breastfeeding. Breastfeed Med 2015; 10:63-8. [PMID: 25389912 DOI: 10.1089/bfm.2014.0066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists (ACOG) recommend exclusive breastfeeding for the first 6 months, only 14.6% of babies born in the District of Columbia (DC) reached this goal. Breastfeeding support from providers has been shown to increase exclusive breastfeeding. We aim (1) to describe breastfeeding knowledge and attitudes, (2) to determine the presence of breastfeeding in routine prenatal discussions, and (3) to determine the knowledge of facility adoption of the Perinatal Care (PC) Core Measure Set among DC ACOG members. A survey sent to DC ACOG members assessed knowledge, attitudes, and practices related to breastfeeding and evaluated participants' barriers to breastfeeding counseling, management of breastfeeding challenges, and awareness of facility adoption of the PC Core Measure Set. All 29 respondents reported breastfeeding as the best infant nutrition and that physicians should encourage breastfeeding. However, despite 75% reporting counseling most of their patients regarding breastfeeding, only 27% reported that most of their patients were breastfeeding at the postpartum visit. Participants scored 83% correct on knowledge-based questions. Perceived barriers to breastfeeding counseling included lack of time (66%), reimbursement (10%), and competence in managing breastfeeding problems (7%). Most respondents were unsure of both adoption of, and breastfeeding data collection for, the PC Core Measure Set (52% and 55%, respectively). Participants had knowledge gaps and identified barriers to discussing breastfeeding. There was limited awareness of hospital data collection about breastfeeding. These results indicate a need for more breastfeeding education among DC obstetricians-gynecologists and better outreach about the PC Core Measure Set.
Collapse
Affiliation(s)
- Alexandra M Sims
- 1 Goldberg Center for Community Pediatrics, Children's National Health System , Washington, D.C
| | | | | | | |
Collapse
|
31
|
Kozhimannil KB, Jou J, Attanasio LB, Joarnt LK, McGovern P. Medically complex pregnancies and early breastfeeding behaviors: a retrospective analysis. PLoS One 2014; 9:e104820. [PMID: 25118976 PMCID: PMC4132072 DOI: 10.1371/journal.pone.0104820] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices. METHODS We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status. RESULTS More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52-0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47-0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81-8.94; and AOR = 2.68; 95% CI, 1.70-4.23, respectively). CONCLUSIONS Improving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants.
Collapse
Affiliation(s)
- Katy B. Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Judy Jou
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Laura B. Attanasio
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Lauren K. Joarnt
- Harvard University, Cambridge, Massachusetts, United States of America
| | - Patricia McGovern
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| |
Collapse
|
32
|
Much D, Beyerlein A, Roßbauer M, Hummel S, Ziegler AG. Beneficial effects of breastfeeding in women with gestational diabetes mellitus. Mol Metab 2014; 3:284-92. [PMID: 24749058 PMCID: PMC3986583 DOI: 10.1016/j.molmet.2014.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/05/2014] [Accepted: 01/06/2014] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) increases the future risk of developing type 2 diabetes mellitus (T2DM). There is now a growing evidence that breastfeeding has short- and long-term health benefits for mothers with GDM. Mothers with GDM who breastfeed have improved lipid and glucose metabolic profiles for the first 3 months after birth. However, women with GDM are less likely to breastfeed and, if they do, breastfeeding is usually continued for a shorter duration compared with women without GDM. One long-term prospective study followed women with GDM from delivery for up to 19 years postpartum, and found that breastfeeding for ≥3 months reduced the risk of T2DM and delayed the development of T2DM by a further 10 years compared with breastfeeding for <3 months. However, the physiological mechanisms underlying the protective effects of breastfeeding are still unknown, even though it is important to gain a full understanding of the pathways involved in these effects. Therefore, the purpose of this review is to provide a comprehensive analysis of the recent developments in the field of GDM and breastfeeding. We reviewed data from animal experiments and human studies. We also provide insight into the molecular pathways and describe promising topics for future research.
Collapse
Affiliation(s)
- Daniela Much
- Institute of Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ; Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ; Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Michaela Roßbauer
- Institute of Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ; Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ; Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ; Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| |
Collapse
|