A critical review of the impact of continuing breastfeeding education provided to nurses and midwives

Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review

BACKGROUND

Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally.

METHODS

This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken.

RESULTS

A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies.

CONCLUSION

At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally.

Benefits and issues of education program for nurse-midwives on milk expression care for preterm mothers in postpartum period

Background and aims

Breastfeeding is important for preterm mothers and infants. However, evidence-based practice and standardized education remain inadequate. To implement evidence-based practice, continuous education is mandatory for nurse-midwives. We previously implemented our developed education program on early essential milk expression care for preterm mothers among Japanese nurse-midwives. Herein, we aimed to assess the effects of our education program on nurse-midwives' knowledge of milk expression care for preterm mothers in terms of changes in their correct answer rates for 20 specific knowledge items before and after the education program implementation. We also aimed to identify program-related issues from nurse-midwives' comments to improve the program.

Methods

We conducted a secondary analysis of our previous data and surveyed the knowledge of 36 nurse-midwives who received a similar face-to-face education program on milk expression care for mothers three months before (Pre-1), just before (Pre-2), just after (Post-1), and three months after (Post-2) the program. We obtained their comments at Post-2 and identified issues for program improvement.

Results

The knowledge items, in which the correct answer rates of Post-1 were significantly higher than those of Pre-2, were Verification of the motivation and intent, Benefits of breastfeeding for mothers and infants, Milk volume on the fourth day and at around the second week after birth, Lactogenesis stage 3, Autocrine control, Time between birth and the initiation of milk expression, Early initiation of milk expression, Frequent milk expression, and Duration of pumping. The issues identified were practical training, knowledge retention, and misunderstanding knowledge.

Conclusions

Nurse-midwives' unacquired knowledge of milk expression care for preterm mothers was effectively supplemented by the education program. Pre-education knowledge items with low correct answer rates must be strengthened during in-service education. Practical training, knowledge retention, and misunderstanding knowledge can be improved.

Implementing an education program for nurse-midwives focused on early essential care for breast milk expression among mothers of preterm infants

BACKGROUND

Although breastfeeding guidelines for infants admitted to the neonatal intensive care unit (NICU) have been introduced in Japan, these guidelines have not been reflected in practice. To improve this situation, it is important for nurses and nurse-midwives to acquire knowledge of appropriate care. This study examined changes in nurse-midwives' knowledge, attitude, and implementation of appropriate care after implementing an education program focused on early essential care for breast milk expression among mothers of preterm infants.

METHODS

This pre- and post-intervention study using a single group was conducted from June 2018 to May 2019 and enrolled 36 nurse-midwives in one perinatal medical center. The education program content included nurses' roles in early essential care for milk expression and the necessary care to promoting breast milk production among mothers of preterm infants. The nurse-midwives' knowledge and attitude on care were investigated 3 months before (pre-1), just before (pre-2), just after (post-1), and 3 months after (post-2) the program. The nurse-midwives' care implementation was investigated at pre-1, pre-2, and post-2. During this time, 11 mothers (before: 7, after: 4) reported the status of milk expression for 10 days after birth.

RESULTS

The mean knowledge scores of the nurse-midwives at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p <  0.001, post-2: p <  0.001). The attitude on care scores at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p = 0.010). The care implementation score at post-2 was significantly higher than that at pre-2 in eight items (e.g., Q7 Explain about the effect of initiating milk expression early and assist mothers in it). However, the education program did not cause any changes in the mothers' initiation and frequency of milk expression, and breast milk volume after birth.

CONCLUSIONS

The significant increases in the knowledge, attitude on care, and care implementation scores of the nurse-midwives suggest the beneficial effects of the education program. The small number of mothers in the survey on the practice of breast milk expression limited the full determination of the benefits of the education program for nurse-midwives.

Effect of Continuing Professional Development on Health Professionals' Performance and Patient Outcomes: A Scoping Review of Knowledge Syntheses

PURPOSE

Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes?

METHOD

In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's level 3 and/or 4.

RESULTS

Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 29 (46%) incorporated eLearning interventions-either standalone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus.

CONCLUSIONS

Across health professions, CPD is an umbrella term incorporating formal and informal approaches in a multicomponent approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.

Program Evaluation of a Home Visiting Program: Perspectives of Home Visitors

The purpose of this program evaluation was to determine if home visitors at the Child Development Resources (CDR) home visiting program perceived themselves to have adequate knowledge and resources to support the goals of the program. In addition, we aimed to determine what home visitors found to be facilitators and barriers to a successful program. The project was conducted with a convenience sample of 18 home visitors and included the following instruments: (a) demographics survey, (b) CDR Home Visiting Program Survey, and (c) Breastfeeding Knowledge Questionnaire. Results suggest (a) most of the home visitors believed they had adequate resources and knowledge necessary to support families and children, (b) some perceived barriers to carrying out goals of the home visiting program were financial limitations, lack of internet and mobile devices in many homes, and perception that programs were not designed for families with significant stressors such as poverty and mental health difficulties, (c) most of the home visitors believed their families benefit from their visiting programs, but many did not overwhelmingly feel new technology would greatly help families during home visits, and (d) most home visitors appeared to have adequate breastfeeding knowledge, however, some suggested that additional breastfeeding education would be beneficial. The information gathered from this project can be used to inform and improve home visiting programs seeking to enhance the quality of their programs which will ultimately contribute to better health outcomes for at-risk mothers and children.

The effect of maternity practices on exclusive breastfeeding rates in U.S. hospitals

The Baby-friendly Hospital Initiative (BFHI) includes a set of 10 evidenced-based maternity practices that when used together have been shown to improve breastfeeding outcomes. In 2007, the Centers for Disease Control and Prevention launched the Maternity Practices in Infant Nutrition and Care (mPINC) survey to assess and monitor these and other evidenced-based maternity practices. The purpose of this study was to explore individual maternity practices measured in the 2013 mPINC survey, along with hospital demographic information, and their relationships with exclusive breastfeeding (EBF) rates, using a sample of United States (U.S.) hospitals. We obtained mPINC survey data from 69 BFHI hospitals and 654 non-BFHI hospitals in the U.S., and EBF rates from The Joint Commission, a leading hospital accreditation agency. On the basis of linear regression analysis, we found that most maternity practices studied were significantly associated with EBF rates (max adjusted R2  = 14.9%). We found a parsimonious model with an adjusted R2 of 47.3%. This study supports the need for a systematic approach in providing breastfeeding support as no one maternity care practice was able to explain the variability in EBF rates as well as a collection of maternity care practices.

Breastfeeding knowledge and attitudes of baccalaureate nursing students in Taiwan: A cohort study

BACKGROUND

Optimal nutrition during the first year of life is critical to infants' healthy growth and development. Hence, it is vital that undergraduate health professional curricula provide good quality learning environments to enable students to acquire the necessary knowledge and skills to support breastfeeding mothers.

AIMS

To examine the change in knowledge and attitude in Taiwanese nursing students following theoretical and clinical learning experiences on breastfeeding.

METHODS

This study used a pre-test/post-test survey design with two cohorts of nursing students (N=215). Knowledge and attitude were assessed before and after: (a) theoretical (didactic and skills laboratory) education in Cohort One, and (b) clinical placement in Cohort Two.

FINDINGS

Students in both cohorts demonstrated significant improvements in knowledge and attitude post-theoretical education, and post-clinical placement. Prior to theoretical education in Cohort One, those with experience of close family members being breastfed were more than 14 times (adjusted odds ratio: 14.09, 95% confidence interval: 1.73-114.64) to be in the high knowledge group. However, following theoretical or clinical education, there were no sociodemographic group differences in breastfeeding knowledge or attitude in Cohorts One or Two.

CONCLUSION

Results revealed that the current breastfeeding education program in Taiwan, both theoretical and clinical components, increased nursing students' knowledge and improved positive attitudes towards breastfeeding, and any sociodemographic differences in knowledge and attitude about breastfeeding were ameliorated following theoretical and clinical placement experience focused on breastfeeding.

Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China's one-child policy

BACKGROUND

The Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China's one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China.

METHODS

A concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%.

RESULTS

Compared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (βwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (β = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (βwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (βwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (βwere 3.14; 95% CI: 1.54 to 4.75).

CONCLUSION

CMC is the optimal service for low-risk primiparous women under China's one-child policy, and is worthwhile for a general implementation across China.

Attitudes, Practices, and Knowledge About Human Lactation Among Nursing Students

Background

Nurses are on the front line of the healthcare system and should, therefore, have the evidence-based knowledge to manage breastfeeding.

Objective

The objective of this study was to assess the attitudes and knowledge about human lactation among a group of nursing students.

Methods

An anonymous online survey was sent to all College of Nursing students at a local university in Kentucky.

Results

Nursing students participating in the survey favored breastfeeding over formula-feeding for infants. Lack of knowledge and various misconceptions about breastfeeding were reported. Whether a nursing student has or has not completed a class about human lactation during the nursing program, and has had or not children, significantly influences their attitudes and knowledge towards breastfeeding.

Conclusion

Future studies should focus on identifying if nursing faculty members and nursing students recognize human lactation as a value and central knowledge for nurses.

Influence of Feeding Practices on Malnutrition in Haitian Infants and Young Children

Infant malnutrition remains an important cause of death and disability, and Haiti has the highest prevalence in the Americas. Therefore, preventive strategies are needed. Our aims were (1) To assess the prevalence of malnutrition among young children seen at a health center in Haiti; (2) Examine adherence to infant feeding practices recommended by the World Health Organization (WHO) and the association to nutritional status. This cross-sectional study recruited children from the Saint Espri Health Center in Port Au Prince in 2014. We recorded feeding practices, socio-demographic data, and anthropometric measurements (WHO-2006). We evaluated 278 infants and children younger than two years old, aged 8.08 ± 6.5 months, 53.2% female. 18.35% were underweight (weight/age <-2 SD); 13.31% stunted (length/age <-2 SD), and 13.67% had moderate or severe wasting (weight/length <-2 SD). Malnutrition was associated with male gender, older age, lower maternal education level, and greater numbers of siblings (Chi², p < 0.05). Adherence to recommended breastfeeding practices was 11.8-97.9%, and to complementary feeding practices was 9.7-90.3%. Adherence was associated with a lower prevalence of malnutrition.

CONCLUSION

Prevalence of infant and young child malnutrition in this population is high. Adherence to WHO-recommended feeding practices was associated with a better nutritional status.

Why does the need for medication become a barrier to breastfeeding? A narrative review

PROBLEM

The need for medication during lactation can contribute to the early cessation of breastfeeding.

BACKGROUND

Breastfeeding women may require medication for acute or chronic health conditions. For some women this need for medication can become a barrier to breastfeeding; this is despite the fact that the majority of medications are considered to be compatible with lactation.

AIM

This narrative review aims to investigate factors relating to medicines safety that could contribute to medication unnecessarily becoming a barrier to breastfeeding.

METHODS

A selective literature search using PubMed, Scopus and Google Scholar was conducted over a 6-month period using the search terms "breastfeeding", "lactation", "medication" and "information". Articles were assessed to identify whether they addressed the impact of medication use on the decision to breastfeed.

FINDINGS

Fifty six articles were identified as having appropriate discussion about decision making for the safe use of medication during lactation. Themes identified included variable and conflicting safety advice for medicines; difficulty interpreting risks associated with medicine use; societal pressures faced by the breastfeeding woman; and the varied knowledge and training of health professionals involved in the care of breastfeeding women.

CONCLUSION

Poor quality of information about medicine safety during lactation can contribute to confusion in giving recommendations. This confusion can result in early cessation of breastfeeding or insufficient health care for the breastfeeding woman.

Focused breastfeeding counselling improves short- and long-term success in an early-discharge setting: A cluster-randomized study

Length of postnatal hospitalization has decreased and has been shown to be associated with infant nutritional problems and increase in readmissions. We aimed to evaluate if guidelines for breastfeeding counselling in an early discharge hospital setting had an effect on maternal breastfeeding self-efficacy, infant readmission and breastfeeding duration. A cluster randomized trial was conducted and assigned nine maternity settings in Denmark to intervention or usual care. Women were eligible if they expected a single infant, intended to breastfeed, were able to read Danish, and expected to be discharged within 50 hr postnatally. Between April 2013 and August 2014, 2,065 mothers were recruited at intervention and 1,476 at reference settings. Results show that the intervention did not affect maternal breastfeeding self-efficacy (primary outcome). However, less infants were readmitted 1 week postnatally in the intervention compared to the reference group (adjusted OR 0.55, 95% CI 0.37, -0.81), and 6 months following birth, more infants were exclusively breastfed in the intervention group (adjusted OR 1.36, 95% CI 1.02, -1.81). Moreover, mothers in the intervention compared to the reference group were breastfeeding more frequently (p < .001), and spend more hours skin to skin with their infants (p < .001). The infants were less often treated for jaundice (p = 0.003) and there was more paternal involvement (p = .037). In an early discharge hospital setting, a focused breastfeeding programme concentrating on increased skin to skin contact, frequent breastfeeding, good positioning of the mother infant dyad, and enhanced involvement of the father improved short-term and long-term breastfeeding success.

Education and training of healthcare staff in the knowledge, attitudes and skills needed to work effectively with breastfeeding women: a systematic review

BACKGROUND

Current evidence suggests that women need effective support to breastfeed, but many healthcare staff lack the necessary knowledge, attitudes and skills. There is therefore a need for breastfeeding education and training for healthcare staff. The primary aim of this review is to determine whether education and training programs for healthcare staff have an effect on their knowledge and attitudes about supporting breastfeeding women. The secondary aim of this review was to identify whether any differences in type of training or discipline of staff mattered.

METHODS

A systematic search of the literature was conducted using the Cochrane Pregnancy and Childbirth Group's trial register. Randomised controlled trials comparing breastfeeding education and training for healthcare staff with no or usual training and education were included if they measured the impact on staff knowledge, attitudes or compliance with the Baby Friendly Hospital Initiative (BFHI).

RESULTS

From the 1192 reports identified, four distinct studies were included. Three studies were two-arm cluster-randomised trials and one was a two-arm individual randomised trial. Of these, three contributed quantitative data from a total of 250 participants. Due to heterogeneity of outcome measures meta-analysis was not possible. Knowledge was included as an outcome in two studies and demonstrated small but significant positive effects. Attitudes towards breastfeeding was included as an outcome in two studies, however, results were inconsistent both in terms of how they were measured and the intervention effects. One study reported a small but significant positive effect on BFHI compliance. Study quality was generally deemed low with the majority of domains being judged as high or unclear risk of bias.

CONCLUSIONS

This review identified a lack of good evidence on breastfeeding education and training for healthcare staff. There is therefore a critical need for research to address breastfeeding education and training needs of multidisciplinary healthcare staff in different contexts through large, well-conducted RCTs.

The North Carolina Lactation Educator Training Program

The North Carolina Lactation Educator Training Program (NCLETP) provides healthcare professionals working in health departments, hospitals, and care provider offices with the tools to educate women about breastfeeding and to support breastfeeding women to achieve their breastfeeding goals. In addition to 5 didactic days and an independent study, the NCLETP offers 2 clinical days, which gives learners an opportunity to apply the information learned in the classroom to clinical practice. The program empowers learners to return to their home communities and make a difference by providing breastfeeding education and support.

Process-oriented training in breastfeeding for health professionals decreases women's experiences of breastfeeding challenges

BACKGROUND

The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women's satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months.

METHODS

An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n = 540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n = 162) started before the intervention was initiated. Data for control group B (n = 172) were collected simultaneously with the intervention group (IG) (n = 206). Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.

RESULTS

Women in IG were more satisfied with the breastfeeding counselling (p = 0.008) and felt the breastfeeding counselling was more coherent (p = 0.002) compared to control groups, when exclusive breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p = 0.01).

CONCLUSION

A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in line with their planned breastfeeding duration, compared to women who had breastfeeding duration < 3 months.

TRIAL REGISTRATION

ACTRN12611000354987.

Factors influencing the intention of perinatal nurses to adopt the baby-friendly hospital initiative in southeastern quebec, Canada: implications for practice

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice.

Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review

Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.

Conhecimento de estudantes de um curso de Enfermagem sobre aleitamento materno

OBJETIVO: Investigar os conhecimentos dos estudantes do 1º e 4º ano de um curso de Bacharelado em Enfermagem, sobre aleitamento materno. MÉTODOS: Estudo de abordagem quantitativa, observacional, transversal e descritivo desenvolvido em uma universidade pública do estado de São Paulo. O instrumento de coleta de dados continha 25 questões, distribuídas em sete blocos. A análise fundamentou-se na estatística descritiva e Teste de Mann-Whitney. RESULTADOS: Participaram da pesquisa 66 alunos do 1º ano e 64 do 4º ano. A média de acertos dos alunos do 1º ano foi de 9,9 questões e do 4º ano foi de 17,8 questões (Teste de Mann-Whitney: 35,1 vs. 96,8 [p<0,000]). Em todos os blocos de perguntas os alunos do 4º ano obtiveram maiores escores. CONCLUSÕES: Verificou-se a necessidade de maiores esforços e incentivo para o aproveitamento de outras oportunidades durante a graduação, que possibilitem ao aluno um melhor desempenho para atuar com confiança na prática em prol da amamentação.