Characteristics of Breastfeeding Discussions at the Initial Prenatal Visit

Abstract

Objective To describe the observed characteristics of first prenatal visit breastfeeding discussions between obstetric providers and their pregnant patients. Methods This analysis was part of a larger study involving 69 providers and 377 patients attending their initial prenatal visits at a single clinic. Audio recordings and transcripts from the first 172 visits (including 36 obstetric-gynecology residents, six nurse midwives and five nurse practitioners) were reviewed for breastfeeding discussion occurrence, timing, and initiator of discussions, and adherence to American College of Obstetricians and Gynecologists (the College) prenatal breastfeeding guidelines. Descriptive statistics were used to characterize the sample and frequency of breastfeeding discussions. Logistic regression and chi-square tests were used to examine patterns in women's breastfeeding discussion preferences and discussion occurrence. Conversations were qualitatively analyzed for breastfeeding content. Results Breastfeeding discussions were infrequent (29% of visits), brief (m=39 seconds), and most often initiated by clinicians in an ambivalent manner. Sixty-nine percent of breastfeeding discussions incorporated any College breastfeeding recommendations. Breastfeeding was significantly more likely to be discussed by certified nurse midwives (CNMs) than residents (OR 24.54, 95% CI: 3.78-159.06; p<0.01), and CNMs tended to engage patients in more open discussions. Women indicating a preference for breastfeeding discussions at the first visit (n=19) were more likely to actually have the discussion (p<0.001). Conclusion Observed breastfeeding education at the first prenatal visit was suboptimal. The causes and effect of this deficiency on breastfeeding outcomes remains an important point of investigation.

The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population

“…A recent study documented breastfeeding discussions in only 29% of initial prenatal visits. 21 Potential barriers to providing education in a clinical setting include lack of adequate provider training, time constraints, lack of reimbursement, and the wide array of other topics that must be addressed at each visit. [22][23][24] One-on-one peer counseling has been shown to be effective; however, cost and training requirements may hinder implementation.…”

Factors Associated with Early Weaning According to the Report of Mothers in a Child Friendly Hospital Initiative

“…Health professionals can and should play an important role in providing guidance on breastfeeding for women in the pre-and postnatal stages, and encouraging breastfeeding [12][13][14].…”

“…Weaning demonstrations show the difficulties that mothers have in dealing with a child crying, associating it with hunger and the idea that milk production is low and weak, and therefore insufficient to satisfy it [16]. Failure to observe the concrete output of the milk, and the manifestation of the child's dissatisfaction as frequent crying cast doubt on the idea that the mother's milk is adequately supplying the child's needs [13,17]. In this case, the woman's posture is quiet and comfortable in the face of weaning, because ultimately, either the infant cries a lot, or they do not sleep, or because they do not want to be breastfed, it is the infant "responsible" for the introduction of the bottle or complete weaning [18].…”

“…It is important to note that in relation to "maternal attributions" as the cause of weaning, the mother becomes active in the weaning process. The following categories of reasons are included here: mother does not want to breastfeed; contraception; mother considers exclusive breastfeeding insufficient for the infant, either because bottle-feeding is a better and more practical food or because an infant needs other foods; mother is nervous about exclusive breastfeeding; and mother's work [11,13]. It is observed, however, that work was revealed as a hindering or impeding element in breastfeeding [4,12].…”

To assess the impact of various modes of postnatal breastfeeding education in promoting breastfeeding practices

“…Mattar CN et al also showed similar results concluding that printed materials regarding breast feeding alone is not sufficient. 6 Audio visual aid plays an important role in practising better breastfeeding practices. However, study done by Kellam et al showed that there was no improvement using audio-visual aid in hospital breast feeding in low income group.…”