1. Survey Research on MS Obstetricians Who Are Involved in Breastfeeding Education and Support Linda C. McGrath, PhD, IBCLC, LLL Health Educator (CHES) Vincent R. McGrath, EdD Professor, Mississippi State University November 11, 2009 – APHA Expo

2. WHO/UNICEF Global Strategy Optimal infant and young child feeding Lack of breastfeeding – risk factor for infant and children morbidity and mortality Promote, protect, and support breastfeeding Baby-Friendly Hospital Initiative

3. encourage promote protect breastfeeding as the method of infant feeding Specialized training in breastfeeding for all staff members “Ten Steps” World Health Organization

4. WHO/UNICEF Ten Steps 1.Have a written breastfeeding policy. 2.Train all health care staff. 3.Inform all pregnant women. 4.Help mothers initiate breastfeeding. 5.Help mothers who may be separated from their infants. 6.Give newborn infants no food or drink other than breast milk. 7.Practice rooming-in. 8.Encourage breastfeeding on demand. 9.Give no pacifiers to breastfeeding infants. 10.Foster the establishment of breastfeeding support groups and refer mothers to them.

5. International Code of Marketing Breast Milk Substitutes 1981 (WHO/UNICEF) 1994 endorsement of United States Code violations: –Giving of free samples –Displaying product logos in medical facilities –Giving free gifts to mothers –Advertising

6. Healthy People 2010 Federal guidelines to improve health in the United States –Focus on 28 areas –Maternal and infant health BREASTFEEDING OBJECTIVES: –75% at hospital discharge –50% at 6 months –25% at one year and beyond

7. Breastfeeding Education Prenatal period - critical time in the decision to breastfeed Breastfeeding education - positively impacts intention and initiation to breastfeed as well as duration Obstetricians – unique position to offer breastfeeding education and support

8. Mississippi Situation MS children and adolescents - number one for obesity, asthma, and diabetes. Inappropriate infant and young child feeding practices associated with chronic ill health in children. Healthy People 2010 objective – 75% MS breastfeeding rate – 48.3% * U.S. breastfeeding rate – 73.9%* *CDC Brfeeding Report Card 2009

9. Methodology Research Design: Descriptive correlational survey research Population: Obstetric members of 2005 Mississippi State Medical Association Data Collection: 3-wave mailing Data Analysis: Frequencies, percents; cross-tabulations with chi-square tests; one-way ANOVA; p<.05, two-tailed

10. Validity and Reliability Panel of experts - content and face validity of survey instrument Two obstetricians – on panel and one endorsed the research A pilot study - 18 obstetricians who work at Women’s Hospital in Baton Rouge, LA

11. Target Population 232 obstetric members of 2005 MS State Medical Association 36 omitted from this study: –were not obstetricians –moved –retired –were on medical leave 196 = practicing obstetricians 116 participated; 59.2% Note: 54% is mean return response rate for U.S. physicians (Price et al., 2004)

12. MS Obstetricians (N=116) Years in Obstetrics 1-5 yrs13 6-10 yrs21 11-15 yrs19 16-20 yrs26 20 yrs plus36 FemalesMales 8 5 9 12 7 12 3 23 9 27

13. Medical School Training 1-5 6-10 11-15 16-20 20+ Breast Anatomy 10 18 17 22 30 Breastfeeding 6 7 10 10 14 Human Lactation 6 11 11 12 16 Note: N1-5=13; N6-10=21; N11-15=19; N16-20=26; N20+=36

14. Survey Instrument 18 statements based on Ten Steps using a 5- point Likert scale (strongly agree, agree, uncertain, disagree, strongly disagree) 7 questions on awareness of brfeeding support network and policies in local medical facilities (Yes, No, or Don’t Know) 11 questions on maternity care practices (Frequencies reported: Every Visit, Most Visits, Some Visits, One Visit, Never or Don’t Know)

15. An obstetrician’s discussions with prenatal patients about breastfeeding are influential in their decision to choose this infant feeding practice. [F(4,110) = 3.468, p<.05] 20+ yrs 34/36 agree 16-20 yrs 24-26 agree 11-15 yrs14/19 agree3 disagree 6-10 yrs18/21 agree1 disagree 1-5 yrs13/13 agree

16. Breastfed babies less than six months old do not need to be given water. [F(4,110) = 2.497, p<.05] 20+ yrs14/36 agree9 disagree 16-20 yrs 9/26 agree5 disagree 11-15 yrs13/19 agree2 disagree 6-10 yrs13/21 agree3 disagree 1-5 yrs 9/13 agree Note: a total of 38/116 obstetricians reported uncertainty for this item.

17. Breastfeeding is a normal and biologically important infant feeding practice that is critical to the health of motherinfant 20+ yrs19/3629/36 16-20 yrs12/3617/26 11-15 yrs11/1915/19 6-10 yrs17/2119/21 1-5 yrs 7/1310/13

18. If the baby is healthy, breastfeeding within one hour after birth should be encouraged. Agree 20+ yrs34/36 16-20 yrs24/26 11-15 yrs18/19 6-10 yrs18/21 1/5 yrs13/13

19. The use of pacifiers to satisfy breastfed babies interferes with breastfeeding. Agree 20+ yrs10/3617 disagree 16-20 yrs 1/2614 disagree 11-15 yrs 3/19 8 disagree 6-10 yrs 5/2111 disagree 1-5 yrs 2/13 7 disagree

20. MS Obstetricians’ Awareness of The Ten Steps 20+ yrs 7/36(19.4%) 16-20 yrs 3/26(12.0%) 11-15 yrs 2/19(10.5%) 6-10 yrs 3/21(14%) 1-5 yrs 0/13(0%)

21. Awareness of LLLWICIBCLCs 20+ yrs 29/3630/3622/36 16-20 yrs 17/2620/2611/26 11-15 yrs 14/1917/1911/19 6-10 yrs 14/2119/2110/21 1-5 yrs 5/1310/13 5/13

22. Discussions on Breastfeeding AgreePractice 20+ yrs34/3623/36 16-20 yrs24/2615/26 11-15 yrs14/1915/19 6-10 yrs18/2116/21 1-5 yrs13/1311/13

23. Practice of Encouraging BreastfeedingClasses 20+ yrs27/3625/36 16-20 yrs19/2612/26 11-15 yrs16/1913/19 6-10 yrs17/2116/21 1-5 yrs1/13 7/13

24. Practice of Referrals LLL WICIBCLC Other 20+ yrs7/36 4/36 13/36 12/36 16-20 yrs4/26 2/26 9/26 11/26 11-15 yrs2/19 6/19 8/19 6/19 6-10 yrs2/21 4/21 10/21 10/21 1-5 yrs 2/13 4/13 3/13 3/13

25. Practice of Distributing Formula 20+ yrs13/36 16-20 yrs11/26 11-15 yrs 8/19 6-10 yrs 10/21 1-5 yrs 6/13 Note: Research reveals that this practice has negative impacts on initiation and duration of breastfeeding as well as exclusive breastfeeding.

26. Implications Unawareness of the Ten Steps Discrepancies in maternity care practices between health districts in MS Suboptimal collaboration among health care professionals Continued distribution of formula packs

27. Recommendations As healthcare professionals involved in breastfeeding promotion and support, we should: Encourage the Ten Steps Become more visible Initiate more collaboration Invite obstetricians etc, to Gold Standard Offer in-service training Lecture in high school and university courses on maternal health and infant nutrition Advocate more state baby-friendly legislation Join your state Breastfeeding Coalition

28. Future Research Survey other health care professionals who serve mothers, infants, and children Conduct Focus Groups with prenatal patients and breastfeeding mothers

29. Resources McGrath, LC. (2006). MS obstetric maternity care practice patterns related to brfeeding education and support. Unpublished dissertation. MSU. Shealy et al. (2005). The CDC guide to breastfeeding interventions. Atlanta: USDHHS, CDC. WHO: Global Strategy for Infant & Young Child Feeding. (2003).

30. Breastfeeding Support Continues