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HUG Your Baby: Preparing Nurse Practitioner Students to Support Breastfeeding. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Nassar L, Van Zandt SN, Nassar G, Nassar R. Increasing Breastfeeding Rates Through Continuity of Care. CLINICAL LACTATION 2022. [DOI: 10.1891/cl.2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundContinuity of care is important in many aspects of medicine, as evidenced by the patient-centered medical home model. The newborn period is an especially important time for continuity of care, as this time sets the stage for lifelong health. Breastfeeding, which is known for its positive health benefits for both mother and child, is the gold standard for infant feeding. While inpatient lactation support is a common amenity available during hospital admission, support can be more difficult to obtain once a patient is discharged. To help eliminate this barrier, a process was put in place within an Eastern Pennsylvania health network’s seven office locations to standardize outreach to the mother-infant dyad.MethodsA quality improvement retrospective chart review comparing pre- and post-intervention rates of exclusive and non-exclusive breastfeeding was completed using one health system’s Electronic Health Record (EHR). A referral process was established to capture dyads born within the health network’s hospital who were going to be followed at one of the seven pediatric offices outpatient. Mothers were called and followed to see how they were progressing with their breastfeeding goals. Any problems were addressed by the health network’s International Board-Certified Lactation Consultants (IBCLCs) and Certified Lactation Counselor (CLC).ResultsLactation rates at the pediatric practice were observed to have increased at both 6 months and 12 months post-intervention compared to pre-intervention.ConclusionProactively scheduling and providing outreach immediately following birth may promote increased breastfeeding rates.
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3
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Spatz DL. Improving Lactation Education and Support in Primary Care. MCN Am J Matern Child Nurs 2021; 46:301. [PMID: 34398832 DOI: 10.1097/nmc.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist in lactation with the Center for Nursing Research & Evidence Based Practice. Dr. Spatz can be reached via email at
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Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice. J Am Assoc Nurse Pract 2021; 33:1273-1281. [PMID: 33534287 DOI: 10.1097/jxx.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breastfeeding is the gold standard for infant feeding. In the United States, 83.2% of women initiate breastfeeding on their infant's birth. When the infant reaches 6 months of age, however, only 57.6% of mothers are still breastfeeding, and a mere 24.9% are breastfeeding exclusively. LOCAL PROBLEM Breastfeeding rates in rural areas are below the national averages. The greatest disparities exist in minorities and individuals with lower educational and socioeconomic status. METHODS A preintervention/postintervention design was used for this quality improvement project. The Model for Improvement's Plan, Do, Study, Act cycle guided the project processes. Breastfeeding rates were obtained at each well-child visit from newborn through 4 months of age. On completion, mean preimplementation and postimplementation breastfeeding rates were compared to determine effectiveness. INTERVENTIONS A breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized via signs and social media postings. RESULTS Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months. CONCLUSIONS This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.
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Kummer L, Duke N, Davis L, Borowsky I. Association of Social and Community Factors with U.S. Breastfeeding Outcomes. Breastfeed Med 2020; 15:646-654. [PMID: 32856942 DOI: 10.1089/bfm.2020.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To explore, in a large, nationally representative U.S. sample of children, potential independent associations between social and community factors and breastfeeding outcomes, using the Social Ecological Model as a theoretical framework. Materials and Methods: A secondary data analysis of the 2011-2012 National Survey of Children's Health was conducted (N = 29,829). Multivariate logistic regression was performed to estimate associations between predictor variables (parental emotional support, neighborhood social support, neighborhood safety, neighborhood amenities, and medical home) and breastfeeding outcomes (breastfeeding initiation [BFI] and exclusive breastfeeding for 6 months [EBF6m]). For predictor variables reaching statistical significance in the adjusted models, we performed subgroup analyses by race-ethnicity. Results: After adjusting for individual- and family-level sociodemographic and maternal-child health factors, living in a neighborhood with 4 amenities was associated with 1.54 (95% confidence interval [CI] 1.06-2.23) times the odds of BFI, compared to children living in neighborhoods with no amenities. There was a negative association (adjusted odds ratio [aOR] 0.83; 95% CI 0.70-0.99) between neighborhood social support and BFI, although living in a supportive neighborhood was associated with 1.37 (95% CI 1.11-1.69) times the odds of EBF6m. There was a negative association (aOR 0.71; 95% CI 0.54-0.93) between perceived neighborhood safety and EBF6m. The observed associations differed by race-ethnicity. Conclusion: Community-level structural and social support factors influence breastfeeding outcomes, independent of previously described individual level sociodemographic factors, and the observed associations differ by race-ethnicity. These findings have implications for the development of "breastfeeding-friendly" communities and public policies.
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Patterson JA, Keuler NS, Eglash AR, Olson BH. Outpatient Breastfeeding Champion Program: Breastfeeding Support in Primary Care. Breastfeed Med 2020; 15:44-48. [PMID: 31397581 DOI: 10.1089/bfm.2019.0108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Breastfeeding support offered by trained professionals can increase breastfeeding success. The Outpatient Breastfeeding Champion (OBC) program creates a network of Breastfeeding Champions (typically nurses) who are trained to identify and resolve common breastfeeding issues and refer to lactation professionals as needed. The objective of this study was to evaluate the impact the OBC program on nurses' attitudes toward breastfeeding and self-confidence in providing breastfeeding care. Materials and Methods: The OBC program was implemented in 11 medical offices within a health care system. Nurses were surveyed before (n = 9) and immediately after (n = 9) participating in OBC training sessions, and 6 months following the implementation of the OBC training (n = 15). Data were collected on their breastfeeding attitude and self-confidence in providing breastfeeding care, and the responses at the different time points were compared using Wilcoxon Rank-Sum tests. Results: Nurses' attitudes toward breastfeeding (p = 0.049) and self-confidence in managing breastfeeding position and attachment (p = 0.09) were higher immediately after completion of the OBC training than they were before training. There was no significant difference in either response between immediately after completion and 6 months following training. Conclusion: This study presents a model of breastfeeding care that extends the reach of an International Board Certified Lactation Consultant to improve breastfeeding support in the primary care setting. Nurses' more positive breastfeeding attitudes and self-confidence in providing breastfeeding care following training suggest that the use of a breastfeeding training program may improve the breastfeeding support provided by nurses, which could be sustained over time.
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Affiliation(s)
- Julie A Patterson
- Department of Nutrition, Dietetics and Wellness, College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois.,Department of Nutritional Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nicholas S Keuler
- Department of Statistics, College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anne R Eglash
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Beth H Olson
- Department of Nutritional Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin
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Milinco M, Cattaneo A, Macaluso A, Materassi P, Di Toro N, Ronfani L. Prevalence of breastfeeding in a baby-friendly pediatric practice: an experience in Trieste, Italy. Int Breastfeed J 2019; 14:44. [PMID: 31673275 PMCID: PMC6815012 DOI: 10.1186/s13006-019-0239-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background In a pediatric practice in Italy, actions were undertaken to apply the recommendations for a breastfeeding-friendly physician’s office and to promote the adoption of a semi-reclined or laid-back maternal position in breastfeeding. The aim of this study is to evaluate the effect of the actions implemented, in terms of prevalence of exclusive breastfeeding. Methods A historical cohort study was carried out using administrative data routinely collected. All women who gave birth in 2016 and registered their newborns with the pediatric practice were included, only mothers of preterm newborns < 30 weeks gestational age were excluded. The main actions undertaken were: employment of a breastfeeding peer supporter; ensuring unlimited daily access in case of breastfeeding difficulties; provision of individual support to breastfeeding mothers in a dedicated room and advice on the laid-back position; scheduling of weekly meetings of small groups for breastfeeding support. Each infant was followed up for five months. The main study outcomes were duration of exclusive breastfeeding (only breast milk and no other liquids or solids, except for drops of syrups with nutritional supplements or medicines) and prevalence at five months. Results A total of 265 newborn infants with a gestational age greater than 30 weeks were registered with the pediatric practice during the study period, about 18% of all infants born in Trieste in that period. Complete data were available for 252 of these (95.1%). The rate of exclusive breastfeeding at five months of age was higher than the one reported for the whole infant population of Trieste and of the Friuli Venezia Giulia Region (62.3% vs. 42.9% vs. 30.3%) in the same period. Conclusions The implementation of breastfeeding-friendly pediatric practice and the application of laid-back breastfeeding may improve the rate and duration of exclusive breastfeeding.
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Affiliation(s)
- Mariarosa Milinco
- 1Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Adriano Cattaneo
- 1Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Luca Ronfani
- 1Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Haase B, Brennan E, Wagner CL. Effectiveness of the IBCLC: Have we Made an Impact on the Care of Breastfeeding Families Over the Past Decade? J Hum Lact 2019; 35:441-452. [PMID: 31206324 DOI: 10.1177/0890334419851805] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants. RESEARCH AIM To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC's role. METHODS The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008-2019. Qualitative and quantitative studies were reviewed. RESULTS Twelve (N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC's role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed. CONCLUSION In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.
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Affiliation(s)
- Barbara Haase
- 1 Medical University Of South Carolina, Department of Women's and Children's Services, Charleston, SC 29425, USA
| | - Emily Brennan
- 2 Medical University of South Carolina (MUSC) Library, Charleston, SC, USA
| | - Carol L Wagner
- 3 Medical University of South Carolina, Department of Pediatrics, Charleston, SC, USA
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Sociodemographic predictors of exclusive breast-feeding among low-income women attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme. Public Health Nutr 2019; 22:1667-1674. [PMID: 30803466 DOI: 10.1017/s1368980019000119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe infant feeding practices and predictors of exclusive breast-feeding among women attending a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme. DESIGN Cross-sectional survey. Outcomes included reported infant feeding practices at 3 and 6 months, timing and reasons for introduction of formula. Descriptive statistics, χ 2 tests and logistic regression were used describe the sample and explore relationships between variables. SETTING Loudoun County, VA, USA. SUBJECTS A sample of 190 predominantly Hispanic women attending local WIC clinics. RESULTS Overall, 84 % of women reported ever breast-feeding and 61 % of infants received formula in the first few days of life. Mothers who reported on infant feeding practices were less likely to exclusively breast-feed (34 v. 45 %) and more likely to provide mixed feeding (50 v. 20 %) at 3 months compared with 6 months, respectively. Significant (P<0·05) predictors of exclusive breast-feeding at 3 months included setting an exclusive breast-feeding goal and completing some high school (compared with completing high school or more). Only education remained a significant predictor of exclusive breast-feeding at 6 months. CONCLUSIONS A high proportion of women reported giving formula in the first few days of life and many changed from mixed to exclusive breast-feeding or formula by 6 months, suggesting possibly modifiable factors. Further investigation can help drive direct service- as well as policy and systems-based interventions to improve exclusive breast-feeding.
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Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
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Holtzman O, Usherwood T. Australian general practitioners' knowledge, attitudes and practices towards breastfeeding. PLoS One 2018; 13:e0191854. [PMID: 29489841 PMCID: PMC5830034 DOI: 10.1371/journal.pone.0191854] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 01/14/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to explore the knowledge, attitudes and practices of established general practitioners (GPs) in relation to breastfeeding. 10 GPs in the Australian Nepean Blue Mountains Health District were interviewed and the interviews transcribed and analyzed thematically. Emergent themes from each interview were identified and then compared between and across the 10 interviews. Five themes emerged following the analysis: breastfeeding knowledge and training; attitudes towards breastfeeding; GPs' role in relation to breast feeding; GPs' practices; influence of male gender. All the GPs interviewed had positive attitudes towards breastfeeding, however they were often lacking in knowledge and conviction to be able to provide strong support to women during their breastfeeding journey. Some reported ambivalence in their encouragement of breastfeeding due to their desire to maintain a good relationship with women who chose not to feed this way. Nine of the GPs had little or no formal breastfeeding training and relied mainly on personal experience. Their clinics did not provide formal breastfeeding support including a written breastfeeding friendly policy and most GPs were not proactive in creating such an environment. We hope that the results from this study will assist in developing breastfeeding policies and professional education to support GPs in this role.
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Affiliation(s)
- Orit Holtzman
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Sydney, NSW, Australia
- Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- * E-mail:
| | - Tim Usherwood
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Sydney, NSW, Australia
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Abstract
The numerous benefits for both mother and baby of breastfeeding are evidence-based and well-defined. Breastmilk is the physiologic norm for infant nutrition, offering multiple health benefits and protections for mothers and babies. Although major medical and health organizations, which represent the health of women and children, such as the American Academy of Pediatrics (AAP), American College of Obstetrics and Gynecology (ACOG), American Academy of Family Practice (AAFP), Centers for Disease Control (CDC), UNICEF, the World Health Organization (WHO) and the National Public Health Service (NPHS), all recommend exclusive breastfeeding, few women meet the recommended goals for duration and exclusivity, despite high initiation rates. This article will discuss the barriers women face when breastfeeding. Strategies will be discussed on how physicians and health care providers can assist and advocate for their mothers while helping to improve the health of women and children. Physicians/pediatricians can support women and design interventions that can help patients' mothers overcome these challenges.
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Affiliation(s)
- Natasha K Sriraman
- Division of General Academic Pediatrics, Children's Hospital of The King's Daughters/Eastern Virginia Medical School, Norfolk, VA
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Abstract
The landscape of breastfeeding has changed over the past several decades as more women initiate breastfeeding in the postpartum period and more hospitals are designated as Baby-Friendly Hospitals by following the evidence-based Ten Steps to Successful Breastfeeding. The number of births in such facilities has increased more than sixfold over the past decade. With more women breastfeeding and stays in the maternity facilities lasting only a few days, the vast majority of continued breastfeeding support occurs in the community. Pediatric care providers evaluate breastfeeding infants and their mothers in the office setting frequently during the first year of life. The office setting should be conducive to providing ongoing breastfeeding support. Likewise, the office practice should avoid creating barriers for breastfeeding mothers and families or unduly promoting infant formula. This clinical report aims to review practices shown to support breastfeeding that can be implemented in the outpatient setting, with the ultimate goal of increasing the duration of exclusive breastfeeding and the continuation of any breastfeeding.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | - Amy J. Hatcher
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
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Clinical Management of the Breast-Feeding Mother-Infant Dyad in Recovery From Opioid Dependence. J Addict Nurs 2017; 27:68-77. [PMID: 27272990 DOI: 10.1097/jan.0000000000000117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human milk is one of the most health-promoting and cost-effective nutritional substances known to humankind. Breastmilk provides substantial and remarkable physiological and psychological health benefits. Within the last decade, there has been a resurgence of breast-feeding in the United States and worldwide and an increased awareness of the immense health benefits for mothers, infants, and societies that support it. Each mother-baby dyad is a unique pair, with distinct relationships, biases, barriers, and obstacles. This article aims to address clinical management for the opioid-recovering breast-feeding dyad and to translate current evidenced-based practice findings, recommendations, and resources to best support this unique population. The recovering breast-feeding mother and newborn with opioid dependence deserve special consideration and expert care to foster their recovery and breast-feeding efforts. It is our moral and ethical responsibility as healthcare professionals to enable, foster, and promote breast-feeding among all families, especially those who stand to benefit the greatest. Substance recovery cannot be treated in isolation, nor can breast-feeding efforts; an interdisciplinary professional team effort promises the greatest chances for recovery success. With appropriate evidence-based practice support, training, and intervention by knowledgeable professionals, many women can overcome the biases and obstacles associated with opioid recovery to successfully breast-feed their babies.
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Abstract
BACKGROUND Breastfeeding is the gold standard nutrition for infants, and more than three-fourths of US mother-infant couplets initiate breastfeeding at birth. However, breastfeeding rates plummet after hospital discharge, when mother-infant couplets enter primary care. This quality improvement project examined the effect of a primary care intervention on breastfeeding rates from the newborn visit through the 4-month visit. OBJECTIVE The overall aim of this evidence-based quality improvement project was to increase breastfeeding rates by refining the care provided to a diverse patient population with historically low breastfeeding rates. METHODS Two independent groups of mother-infant couplets, a pre-implementation (N = 43) and a post-implementation (N = 45), were longitudinally evaluated on breastfeeding rates at the newborn, 1-month, 2-month, and 4-month well-child visits for exclusive, partial, and any breastfeeding rates. Relationships for the 2 groups were compared using 2-sample t tests, chi-square, and Fisher exact tests. RESULTS Post-implementation rates for any breastfeeding progressively increased at each timepoint. Exclusive breastfeeding increased 40.98% at the 1-month visit, 27.4% at the 2-month visit, and 139% at the 4-month visit. CONCLUSION The implementation of an evidence-based breastfeeding-friendly office protocol in a rural low breastfeeding rate primary care setting was associated with increased breastfeeding rates.
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Affiliation(s)
| | | | - Myra Clark
- 1 University of North Georgia, Dahlonega, GA, USA
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Sriraman NK, Kellams A. Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals. J Womens Health (Larchmt) 2016; 25:714-22. [PMID: 27111125 DOI: 10.1089/jwh.2014.5059] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite recognized health benefits for both mothers and infants, significant disparities still exist in the rates of breastfeeding in the United States. Major organizations representing the health of women and children (including the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics [AAP], American Congress of Obstetrics and Gynecology [ACOG], American Academy of Family Physicians [AAFP], United Nations International Children's Emergency Fund (UNICEF), the World Health Organization [WHO], and the United States Public Health Service [PHS]) recommend exclusive breastfeeding, but statistics show that although many women initiate breastfeeding, few meet the recommended goals for duration and exclusivity. This article reviews the evidence related to barriers (prenatal, medical, societal, hospital, and sociocultural) that many mothers face, and explore the known barriers and the impact they have on a woman's ability to breastfeed her infant. Strategies will be discussed to address (and potentially overcome) some of the most common barriers women face along with a list of resources that can be useful in this effort. Gaps in care and areas that need further research will be noted. This article is targeted toward physicians and other healthcare providers who work with women and who can assist with and advocate for the removal of barriers and thereby improve the health of women and children by increasing the rates of breastfeeding initiation, duration, and exclusivity in the United States.
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Affiliation(s)
- Natasha K Sriraman
- Division of General Academic Pediatrics, Children's Hospital of the King's Daughters/Eastern Virginia Medical School , Norfolk, Virginia.,Well Newborn and Breastfeeding Medicine Services, Department of Pediatrics, University of Virginia , Charlottesville, Virginia
| | - Ann Kellams
- Division of General Academic Pediatrics, Children's Hospital of the King's Daughters/Eastern Virginia Medical School , Norfolk, Virginia.,Well Newborn and Breastfeeding Medicine Services, Department of Pediatrics, University of Virginia , Charlottesville, Virginia
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Rosen-Carole C, Hartman S. ABM Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Setting, Revision 2015. Breastfeed Med 2015; 10:451-7. [PMID: 26651541 PMCID: PMC4685902 DOI: 10.1089/bfm.2015.29016.ros] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Casey Rosen-Carole
- Department of General Pediatrics, University of Rochester, Rochester, New York
| | - Scott Hartman
- Department of Family Medicine, University of Rochester, Rochester, New York
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18
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Schwartz R, Ellings A, Baisden A, Goldhammer CJ, Lamson E, Johnson D. Washington 'Steps' Up: A 10-Step Quality Improvement Initiative to Optimize Breastfeeding Support in Community Health Centers. J Hum Lact 2015; 31:651-9. [PMID: 26124223 DOI: 10.1177/0890334415591147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breastfeeding initiation in Washington State (Northwest United States) is high, yet rates plummet by 3 months postpartum. In the United States, national quality improvement (QI) efforts to improve breastfeeding outcomes have largely focused on hospital maternity care practices through implementation of the Ten Steps to Successful Breastfeeding. This framework has not extended similarly to primary care clinics, a key site for supporting continued breastfeeding following hospital discharge. This article details a pilot effort with community clinics to implement 10 evidence-based steps to support breastfeeding in the clinic setting and to evaluate the process and outcomes. OBJECTIVE A public-private-academic partnership developed and piloted a 10-step clinic breastfeeding support strategy and focused resources, training, and technical assistance on primary care clinics to help facilitate best-practice policy and environmental changes to improve clinic breastfeeding support. METHODS Eight health centers, serving predominantly Latino and Native American communities, worked to systematically implement 10 evidence-based steps developed for the community primary care setting. An evidence table, self-assessment with scoring criteria, tool kit, and provider reference documents were developed to guide clinics. RESULTS At baseline, clinics had 2 steps, on average, already in practice (range, 1-4 steps); by final assessment, an average of 7 steps was implemented (range, 5-9 steps). Within 6 months from pre-intervention to post, clinics fully operationalized between 2 and 7 steps. CONCLUSION Catalyzing clinic QI efforts through an evidence-based 10-step model is an effective way to optimize primary care breastfeeding support and to strengthen the continuum of care for breastfeeding mothers and babies following hospital discharge.
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Affiliation(s)
| | - Amy Ellings
- Washington State Department of Health, Olympia, WA, USA
| | | | | | - Erica Lamson
- University of Washington Center for Public Health Nutrition, Seattle, WA, USA
| | - Donna Johnson
- University of Washington Center for Public Health Nutrition, Seattle, WA, USA
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Johnson DB, Lamson E, Schwartz R, Goldhammer C, Ellings A. A Community Health Clinic Breastfeeding-Friendly Pilot: What Can We Learn about the Policy Process? J Hum Lact 2015; 31:660-70. [PMID: 25832650 DOI: 10.1177/0890334415579656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implementing evidence-based practices and policies for breastfeeding support in community clinics is a promising, but challenging, approach to reducing disparities in breastfeeding rates. OBJECTIVE This study aimed to apply a policy process research framework to increase knowledge of factors that facilitate adoption and implementation of breastfeeding policy changes. METHODS In 2013, Washington State piloted a process to encourage 8 clinics to adopt and implement steps to become breastfeeding friendly. Evaluation data were collected through interviews, project reports, training evaluations, and pre- and post-self-assessments of achievement of the steps. RESULTS In 6 months, clinics increased the breastfeeding-friendly steps that they were implementing from a median (interquartile range) of 1.5 (0-3) to 6 (5-7). Improvements were most likely in the steps that required the fewest resources and administrative changes. Barriers to implementation included misperceptions about breastfeeding and breastfeeding support; lack of administrative "buy-in"; need for organizational changes to accommodate actions like monitoring breastfeeding rates and allowing providers training time; and the social-political climate of the clinic. Several factors, including actions taken by public health practitioners, enhanced the change process. These included fostering supportive relationships, targeting technical assistance, and providing resources for planning and training. CONCLUSION This pilot project demonstrates that it is possible to make changes in breastfeeding support practices and policies in community clinics. Recommendations to enhance future work include framing and marketing breastfeeding support in ways that resonate with clinic decision makers and enhancing training, resources, and advocacy to build capacity for internal and external systems changes to support breastfeeding best practices.
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Affiliation(s)
- Donna B Johnson
- University of Washington Center for Public Health Nutrition, Seattle, WA, USA
| | - Erica Lamson
- University of Washington Center for Public Health Nutrition, Seattle, WA, USA
| | | | | | - Amy Ellings
- Washington State Department of Health, Olympia, WA, USA
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Abstract
INTRODUCTION Prenatal breastfeeding education increases breastfeeding initiation, exclusivity, and duration. Current research regarding antenatal breastfeeding education suggests that recurrent, individual, and technology-based education programs are effective in providing women with evidence-based breastfeeding information and guidance. MATERIALS AND METHODS This project was implemented at an obstetrical practice in the northeast United States. Pregnant women between 32 weeks of gestation and birth, receiving care from certified nurse-midwives, were the targeted population. Three breastfeeding modules were created and offered to women at the 32-, 34-, and 36-week prenatal visit via computer tablets. Women answered questionnaires at the end of each module, serving as a measure for participation and content learning. Women also completed a questionnaire at the 6-week postpartum visit to assess summative perceptions. RESULTS Twenty-three women participated, and 21 women completed questionnaires at 6 weeks postpartum. All women answered the content questions at the end of the modules correctly. Sixty-seven percent reported prior breastfeeding experience, 95% initiated breastfeeding, 86% were exclusively breastfeeding at 6 weeks postpartum, and 71% of the women planned to exclusively breastfeed for 6 months. Sixty-seven percent reported the modules promoted or affirmed their decision to breastfeed, whereas 5% would have preferred group-based education. Providers documented breastfeeding education 52% of the time. CONCLUSIONS The results of this project indicate that women successfully learned breastfeeding content via the tablet methodology. The results confirm that prenatal breastfeeding education, in the office setting, is well accepted by women. In order to assess the impact of the program on breastfeeding success, further study is needed.
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Affiliation(s)
- Adrienne Pitts
- Baylor University Louise Herrington School of Nursing , Dallas, Texas
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Bueno-Gutierrez D, Chantry C. Using the socio-ecological framework to determine breastfeeding obstacles in a low-income population in Tijuana, Mexico: healthcare services. Breastfeed Med 2015; 10:124-31. [PMID: 25574870 DOI: 10.1089/bfm.2014.0109] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In Mexico, breastfeeding rates are one of the lowest of Latin America, with 14.4% of infants under 6 months being exclusively breastfed. Previous studies indicate that lack of support from healthcare services is a serious obstacle to breastfeeding mothers in Mexico. Our objective was to identify the main obstacles to breastfeeding presented by the healthcare services in a low-income population in Tijuana, Mexico. MATERIALS AND METHODS We used a socio-ecological framework to determine factors affecting breastfeeding practices. In four low-income communities in Tijuana we conducted focus groups and interviews with mothers, fathers, grandparents, and key informants. Interview notes and focus group transcripts were then studied in-depth independently by three researchers. The primary analytic technique was constant comparison. RESULTS One hundred twenty-nine subjects participated in this study: six focus groups (n=53) and 51 interviews among mothers, fathers, and grandparents, as well as 25 interviews among key informants. Main healthcare service obstacles to breastfeeding were erroneous information, lack of training and supervision, negative attitudes, miscommunication between healthcare providers (HCPs) and patients, detrimental medical practices such as giving free formula at hospitals, and the conflict of interest between the infant food industry and the HCPs. CONCLUSIONS This study showed that women in low-income communities in Tijuana face multiple obstacles to breastfeeding presented by healthcare services. In order to increase breastfeeding rates, institutional and structural changes are required.
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Affiliation(s)
- Diana Bueno-Gutierrez
- 1 Department of Medicine, Autonomous University of Baja California , Tijuana, Mexico
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Boucher NA, Mcmillen MA, Gould JS. Agents for change: nonphysician medical providers and health care quality. Perm J 2015; 19:90-3. [PMID: 25663213 DOI: 10.7812/tpp/14-095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.
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Affiliation(s)
- Nathan A Boucher
- Assistant Professor and Director of Graduation Education in the Physician Assistant Program in the School of Health Sciences at Touro College in New York, NY.
| | - Marvin A Mcmillen
- Medical Director of Surgical Services at Bristol Hospital in Bristol, CT.
| | - James S Gould
- Chief Physician Assistant in the Surgery Department at Beth Israel Medical Center in New York, NY.
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Eidelman AI. It takes a village and beyond to support breastfeeding. Breastfeed Med 2013; 8:243-4. [PMID: 23573800 DOI: 10.1089/bfm.2013.9993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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