1. Prenatal Breastfeeding Promotion Project
Cami Hebert, Arthi Krishnan, MD, Alma Rivera, RN, BSN, IBCLC, Ellie Kourosh, MS, DrPH, Atoosa Kourosh, MD, MPH
University of Texas Southwestern Medical Center, MS1
Introduction
The AAP recommends exclusive breastfeeding for the first six months of a baby's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.1 In Texas, the rate of breastfeeding initiation is nearly 80%; however, less than 50% are still breastfeeding at 6 months of age. The rate of breastfeeding further drops to 25% by 1 year of age. By 3 months of age, only 36% of infants have been exclusively breastfed and less than 15% of infants are exclusively breastfed by 6 months of age.2 The statistics clearly indicate that this is an area of need with respect to parent education and support.
Physicians’ and healthcare staff’s attitudes about breastfeeding and level of support offered to mothers has been shown to be predictive of breastfeeding practices. In one study, mothers who perceived that hospital staff had no preference on whether she breastfed or not were significantly more at risk for breastfeeding failure.3 It has been shown that implementing office protocols for breastfeeding promotion is successful in increasing the rates of initiation and maintenance of breastfeeding.4
Results
Encouragingly, 95% of expectant mothers in the first trimester reported that they intended to breastfeed. However, only 67% felt that they had adequate knowledge about breastfeeding, and 72% of moms desired more information about breastfeeding.
Interestingly, by the third trimester, we saw a slight decrease in the percentage of mothers who reported that they intended to breastfeed their baby (from 95% to 85%). However, the mothers who felt that they had access to information increased to 81%, and the mothers desiring more information decreased dramatically from 72% in the first trimester to only 17% in the third trimester. It is unclear why fewer mothers responded that they intended to breastfeed in the third trimester. Some possible reasons could include the smaller sample size of completed third trimester surveys compared to first trimester surveys (87 versus 159, respectively), response bias, or other confounding factors, including environmental or social issues in the mothers’ lives. Future endeavors could help elucidate the reason for this unanticipated finding.
Over half of the moms surveyed reported in the third trimester that they would be more likely to breastfeed if their doctor recommended it. Of those whose doctor’s recommendation would not make them more likely to breastfeed, an overwhelming majority (94%) said that it was because they were already planning to breastfeed anyway, yet they would still appreciate their doctor’s support.
Abstract
The current epidemic of childhood obesity is a national public health crisis that must be addressed. Studies have shown that children who are breastfed have a lower risk of obesity, and the longer that breastfeeding is maintained, the more protective for the child.5,6
The goal of the DFW Area Prenatal Breastfeeding Promotion Project is to help OB/GYN practices promote breastfeeding education during the prenatal period, and thereby encourage pregnant mothers to choose breastfeeding in order to reduce childhood obesity rates. We have developed a program for OB/GYN clinics to implement breastfeeding counseling into the flow of their prenatal patient care. The OB/GYN clinic promotes breastfeeding in each trimester and provides mothers with the resources needed to the support breastfeeding postpartum. Pregnant mothers complete a first and a third trimester survey about their knowledge and intentions regarding breastfeeding.
Analysis thus far has shown promising results. Survey results indicate that the intervention has been efficacious in providing mothers with the information that they need and desire in order to breastfeed successfully. Future directions for the project will be to continue providing breastfeeding resources, fine-tune the surveys, expand the number of participating practices, and to place all breastfeeding promotion materials online to aid in sustainability of the project.
Conclusions
Although the vast majority of expectant mothers surveyed intend to breastfeed, they are hungry for more information about how to do it successfully. This is promising information that further establishes the need for this project in our community. The intervention has been successful in giving mothers the information that they need, as the number of mothers who want more information about breastfeeding decreased dramatically from 72% to 17% between the first and third trimester.
However, there is still room for improvement—by the third trimester, less than half of moms felt that they had adequate information about support groups for breastfeeding moms, and only 23% reported that they had taken a breastfeeding class. Future efforts can be focused toward providing these resources that moms still report that they are lacking. Also, further analysis and fine-tuning of the surveys will be implemented to shed light on the reason for the slight decrease in mothers who intend to breastfeed and whether this is a factor of sample size or of other confounding factors.
Description of intervention
Armed with the advocacy plan from ‘Be Our Voice’ training and the knowledge of the effectiveness of prenatal breastfeeding promotion in the tertiary care setting, the project team has developed a unique strategy for implementing office-based prenatal breastfeeding education. Breastfeeding promotion throughout pregnancy has proven to be highly effective in increasing the number of women who initiate and maintain breastfeeding. We have trained physicians, RNs, and staff at three different OB/GYN practices to help moms make the decision to breastfeed and encourage proper preparation, initiation, and maintenance. Research shows that the provider simply saying, "I hope you will breastfeed -- it's the best option for you and your baby” at least one time during each trimester makes an impact on the mother’s decision. The nursing staff also supports the pregnant mothers by offering handouts, resources, and verbal feedback on the importance of breastfeeding and prenatal preparation. A media component is implemented by putting up posters and brochures in the waiting room and playing videos on televisions when applicable. The educational materials provided to the practices are complete with community resources, including breastfeeding support groups, breastfeeding friendly businesses, and nearby pediatric offices who can serve as a medical home for the baby and a breastfeeding troubleshooting resource for parents.
We review first and third trimester survey results to determine if the goal of increasing breastfeeding education in OB/GYN offices is being met. Survey questions ask expectant mothers if they feel they were properly counseled on the benefits of breastfeeding and about their knowledge of community resources and their intention to utilize them. Our goal of improving access to information about breastfeeding and community support in the OB office setting is measured through site visits to see if program materials are displayed in offices and if handouts are available.
References
1. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.
2. Centers for Disease Control and Prevention. Breastfeeding report card
3. DiGirolamo A, Grummer-Strawn L, Fein S. Do Perceived Attitudes of Physicians and Hospital Staff Affect Breastfeeding Decisions?. Birth: Issues In Perinatal Care. 2003;30(2):
4. Corriveau S, Drake E, Kellams A, Rovnyak V. Evaluation of an Office Protocol to Increase Exclusivity of Breastfeeding. Pediatrics. 2013;131(5):
5. Jing Y, Lin L, Yun Z, Guowei H, Wang P. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014;14(1):
6. Reynolds D, Hennessy E, Polek E. Is breastfeeding in infancy predictive of child mental well-being and protective against obesity at 9 years of age?. Child: Care, Health & Development. 2014;40(6):
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