Abstract
Dear Editor:
The goal of the training program was to increase healthcare providers' knowledge, attitudes, and perceived confidence and ability in providing guidance for breastfeeding. In addition, physicians and office staff were asked to implement one or more office policies to discourage formula use and to support and encourage breastfeeding. The training program was implemented as a “Lunch n’ Learn” session in which trainers visited physicians' offices to administer a 1-hour slide presentation led by a contracted International Board Certified Lactation Consultant and a physician. The training program was developed specifically for this project by members of the Louisville Metro Department of Public Health and Wellness. To ensure consistency and high fidelity, an orientation session was provided to the education teams that covered the slide presentation, resource packet contents, and details on presenting the program effectively in a short amount of time.
The presentation covered specific details regarding the nutritional composition, superior lifelong health benefits of breastmilk, support often needed by mothers and families to initiate breastfeeding, what are/are not contraindications, facilitators and barriers to breastfeeding, and community resources.
Training staff specifically clarified healthcare providers' unique roles in the birthing process in providing guidance and support to mothers regarding feeding practices. Two distinct presentations were developed to meet the needs of the different types of healthcare providers. The first presentation emphasized prenatal education and support during preconception and postconception and was aimed for obstetricians, whereas the second presentation was aimed for pediatric and family medicine providers and emphasized using prenatal interviews with prospective parents and providing the medical care for infants postpartum. Training was provided to a total of 138 participants during the third quarter of 2010. These providers were estimated to deliver nearly 96% of all newborns in the city (n=9,685 [95.8%]) over the 15-month study period.
Data were collected concerning breastfeeding rates (at discharge) from the total of 10,110 women who delivered at the four birthing hospitals in Louisville during the 15 months following the training sessions. The four contributing hospitals collected data on whether new mothers were breastfeeding at discharge as well as other demographic data. Multivariable logistic regression techniques were used to explore if breastfeeding rates changed over time, with adjusting for age and ethnicity because age and ethnicity may impact breastfeeding rates.
The number of births and the average age of the mother were consistent across the study period (Table 1). The distribution of ethnicity in the study population was similar to the distribution of females of childbearing age in Louisville (62.9% white, 20.3% black, 15.0% Hispanic, and 1.9% other). The mean age remained consistent and was between 27 and 28 years of age for the 15 months of the study. Also, the breastfeeding rate increased over time from 61.3% to 67.6% (p<0.001).
A significant trend over time (p<0.001).
Q, quarter.
The odds of a mother breastfeeding at discharge significantly increased over time following the implementation of the training program, per quarter (odds ratio=1.18, 95% confidence interval 1.13–1.39, p<0.001). Post hoc comparisons suggest that Time Point 1 was significantly different from Time Point 3 (p=0.003), Time Point 4 (p=0.001), and Time Point 5 (p<0.001), although no other significant differences existed between time points.
In addition, over the 15-month study period we found that physician and healthcare provider attitudes and knowledge regarding breastfeeding and providing women with breastfeeding support increased as a result of being exposed to the training. Close to half had removed formula marketing and other paraphernalia from their offices. In addition, two-thirds reported redeveloping policies and procedures to aid them in providing breastfeeding support to pregnant women and mothers.
Our results suggest that a significant increase in breastfeeding initiation can be observed after implementing a training program to improve clinicians' knowledge, attitudes, and knowledge.
There are certainly countless external influences, from family, medical establishment, Internet sources, and more, that affect a woman's decision to breastfeed. No one initiative, such as this initiative, can be shown to be the single factor that is responsible for this positive change. This training initiative was part of a series of steps undertaken to move Louisville toward providing new mothers and families with the support they need to promote breastfeeding and infant health. As such, we can only establish an association between the training program and breastfeeding rates, not a cause-and-effect relationship, although the logistic model developed fits the data well. A future article will explore ways in which the complementary steps/programs work synergistically. A future study will look at the association between the training program and later breastfeeding rates, which the current study was not structured or funded to look at.
The current study introduces the reader to a program aimed to increase the knowledge and attitudes of clinicians who manage pregnant women and new mothers. Our results suggest that the training program is associated with an increase in breastfeeding rates (at discharge). Future articles will address whether this association is retained at later times (3 months, 6 months, 1 year) and whether other factors (socioeconomic status, physician traits, type of facility, etc.) help explain more variance in responses.