Clinician Support and Psychosocial Risk Factors Associated With Breastfeeding Discontinuation

Author:

Taveras Elsie M.12,Capra Angela M.3,Braveman Paula A.4,Jensvold Nancy G.3,Escobar Gabriel J.3,Lieu Tracy A.2

Affiliation:

1. Harvard Pediatric Health Services Research Fellowship Program, Boston, Massachusetts

2. Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts

3. Division of Research, Kaiser Permanente, Oakland, California

4. Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California

Abstract

Objective. Breastfeeding rates fall short of goals set in Healthy People 2010 and other national recommendations. The current, national breastfeeding continuation rate of 29% at 6 months lags behind the Healthy People 2010 goal of 50%. The objective of this study was to evaluate associations between breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support, maternal physical and mental health status, workplace issues, and other factors amenable to intervention. Methods. A prospective cohort study was conducted of low-risk mothers and infants who were in a health maintenance organization and enrolled in a randomized, controlled trial of home visits. Mothers were interviewed in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks. Logistic regression modeling was performed to assess the independent effects of the predictors of interest, adjusting for sociodemographic and other confounding variables. Results. Of the 1163 mother-newborn pairs in the cohort, 1007 (87%) initiated breastfeeding, 872 (75%) were breastfeeding at the 2-week interview, and 646 (55%) were breastfeeding at the 12-week interview. In the final multivariate models, breastfeeding discontinuation at 2 weeks was associated with lack of confidence in ability to breastfeed at the 1- to 2-day interview (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.02–7.6), early breastfeeding problems (OR: 1.5; 95% CI: 1.1–1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1–5.7), and lower maternal education (OR: 1.5; 95% CI: 1.2–1.9). Mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported (during the 12-week interview) having received encouragement from their clinician to breastfeed (OR: 0.6; 95% CI: 0.4–0.8). Breastfeeding discontinuation at 12 weeks was also associated with demographic factors and maternal depressive symptoms (OR: 1.18; 95% CI: 1.01–1.37) and returning to work or school by 12 weeks postpartum (OR: 2.4; 95% CI: 1.8–3.3). Conclusions. Our results indicate that support from clinicians and maternal depressive symptoms are associated with breastfeeding duration. Attention to these issues may help to promote breastfeeding continuation among mothers who initiate. Policies to enhance scheduling flexibility and privacy for breastfeeding mothers at work or school may also be important, given the elevated risk of discontinuation associated with return to work or school.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Reference32 articles.

1. American Academy of Pediatrics Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics.1997;100:1035–1039

2. US Department of Health and Human Services. Developing Objectives for Healthy People 2010. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion; 1997

3. US Department of Health and Human Services. HHS Blueprint for Action on Breastfeeding. Washington, DC: US Department of Health and Human Services, Office on Women’s Health; 2000

4. Scott JA, Binns CW. Factors associated with the initiation and duration of breastfeeding: a review of the literature. Breastfeed Rev.1999;7:5–16

5. Avery M, Duckett LJ, Dodgson J. Factors associated with very early weaning among primiparas intending to breastfeed. Matern Child Health J.1998;2:167–179

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