Evaluating the impact of provider breastfeeding encouragement timing: Evidence from a large population-based study

Abstract

Background: Exclusive breastfeeding is the healthiest and most economical form of infant nutrition. Although research has indicated that professional support increases the length of time women breastfeed, the optimal timing of provider encouragement to sustain mothers' breastfeeding is unknown. We evaluated the impact of the timing of provider encouragement on breastfeeding initiation and three-month duration, especially among racial/ethnic minority mothers who have been underrepresented in breastfeeding outcomes research. Methods:We used data from the 2010 Los Angeles Mommy and Baby (LAMB) Survey. LAMB is a population-based mail survey, distributed to women in Los Angeles County who recently gave birth to a live infant. Participants were asked about their perceptions of provider encouragement of breastfeeding at three specific time points: during prenatal care visits, during the birth hospital stay after the baby was born, and during early well-baby checkups. Mothers were asked whether they breastfed or pumped breast milk to feed their baby after delivery and if they were still breastfeeding at the time of the survey.Results: Overall, 87.6% of LA County mothers initiated breastfeeding after delivery. At 3 months, 60% were still breastfeeding. Adjusted logistic regression analysis showed a positive association between provider encouragement at the delivery hospital and breastfeeding initiation (aOR = 2.7, 95% CI = 1.60-3.96) that was significant across all races/ethnicity. Encouragement during well-baby checkups was positively associated with breastfeeding at 3 months (aOR = 1.5, 95% CI = 1.22-1.93). This latter association was found among all races and ethnicities, except for Black mothers. There was no association between encouragement provided during prenatal care and breastfeeding practices. Conclusions:The optimal timing of provider encouragement on breastfeeding initiation is likely during the birth hospitalization, while sustained breastfeeding likely requires professional support after discharge. Culturally appropriate interventions to maintain positive breastfeeding practices must be identified, especially for black mothers.

Prenatal Provider Breastfeeding Toolkit: Results of a Pilot to Increase Women’s Prenatal Breastfeeding Support, Intentions, and Outcomes

“…Our results are consistent with findings from researchers who previously found that patients value provider breastfeeding recommendations (Chao et al, 2016; Dattilo et al, 2020; Wallenborn et al, 2018). A systematic review and meta-analysis by Kim et al (2018) supported the need for integrated programs for breastfeeding support that include provider training, interventions conducted from the pre- to postnatal period, connections between hospital and community, and involvement of healthcare professionals.…”

“…Our results are consistent with findings from researchers who previously found that patients value provider breastfeeding recommendations (Chao et al, 2016;Dattilo et al, 2020;Wallenborn et al, 2018). A systematic review and meta-analysis by Kim et al (2018) supported the need for Note.…”

“…Provider recommendations influence women’s breastfeeding decisions (Chao et al, 2016; Dattilo et al, 2020; Wallenborn et al, 2018). A study of women with children < 3 years indicated that those receiving provider encouragement to breastfeed were > 4 times more likely to initiate breastfeeding than those who did not (Chao et al, 2016; Lumbiganon et al, 2016; McFadden et al, 2017). Per conclusion from a Cochrane review (McFadden et al, 2017), provider encouragement increased breastfeeding exclusivity at 3 months and breastfeeding duration to 4 months.…”

Intention and Initiation of Breastfeeding Among Women Who Are Incarcerated

“…Breastfeeding initiation is amenable to intervention. The optimal timing of intervention by health care providers may be the birth hospitalization, especially for populations least likely to breastfeed (Chao, Goldfinger, Gozalians, Sun, & Thaker, 2016). As the health care providers who take the lead on breastfeeding support during in-hospital births, nurses can serve as important facilitators or barriers to breastfeeding initiation (CDC, 2015).…”