scholarly journals “Real-world” effect of a peer counselor on breastfeeding outcomes in an urban prenatal clinic in the United States

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Noelle G. Martinez ◽  
Angelina Strohbach ◽  
Fengling Hu ◽  
Lynn M. Yee
Keyword(s):  
Low Income ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Secondary Analysis ◽  
Real Life ◽  
The United States ◽  
Breastfeeding Duration ◽  
Breastfeeding Initiation ◽  
Breastfeeding Support ◽  
Peer Counselor

Abstract Background One approach for improving breastfeeding support and alleviating breastfeeding disparities is the implementation of a clinic-based peer counselor. Our objective was to assess the “real life” effects of an autonomous peer counselor who provides tailored support to low-income, minority women based on individual needs rather than a pre-determined research protocol. Methods This is a secondary analysis of a prospective cohort study of women receiving publicly funded prenatal care during the 6 months before and after introduction of a peer counselor in a single prenatal clinic. The peer counselor provided one-on-one antenatal and postpartum lactation support. Electronic medical record and survey data were collected. The primary outcome was breastfeeding continuation at 6 weeks postpartum. Secondary outcomes included breastfeeding comfort, confidence, and training satisfaction, any breastfeeding, and total breastfeeding duration. Bivariable and multivariable analyses were performed. Results Peer counselor exposure was not associated with the primary outcome of continued breastfeeding at 6 weeks (55.6% with peer counselor versus 49.1% without; aOR 1.26, 95% CI 0.69–2.31). However, women with peer counselor exposure were more likely to be satisfied with breastfeeding training at the time of delivery (98.2% vs. 83.6%, p = 0.006) and were more likely to have performed any breastfeeding (89.8% vs. 78.9%, p = 0.04), which remained significant on multivariable analysis (aOR 2.85, 95% CI 1.11–7.32). Conclusions Peer counselor interventions are a promising approach to increase breastfeeding initiation. Further research is required to inform the most efficacious approach while also allowing peer counselors to operate independently and in line with the specific needs of their clients.

Effectiveness of Workplace Lactation Interventions on Breastfeeding Outcomes in the United States: An Updated Systematic Review

2018 ◽  
Vol 35 (1) ◽  
pp. 100-113 ◽  
Author(s):  
Julia H. Kim ◽  
Jong C. Shin ◽  
Sharon M. Donovan
Keyword(s):  
United States ◽  
Low Income ◽  
Exclusive Breastfeeding ◽  
Maternity Leave ◽  
The United States ◽  
Breastfeeding Duration ◽  
Breastfeeding Initiation ◽  
White Ethnicity ◽  
Observational Study Design ◽  
The Impact

Background Returning to work is one of the main barriers to breastfeeding duration among working mothers in the United States. However, the impact of workplace lactation programs is unclear. Research Aim The aim of this study was to evaluate the effectiveness of workplace lactation programs in the United States on breastfeeding practices. Methods A systematic search was conducted of seven databases through September 2017. Articles ( N = 10) meeting the inclusion criteria of describing a workplace lactation intervention and evaluation in the United States and measuring initiation, exclusivity, or duration using an experimental or observational study design were critically evaluated. Two reviewers conducted quality assessments and reviewed the full-text articles during the analysis. Results Common services provided were breast pumps, social support, lactation rooms, and breastfeeding classes. Breastfeeding initiation was very high, ranging from 87% to 98%. Several factors were significantly associated with duration of exclusive breastfeeding: (a) receiving a breast pump for one year (8.3 versus 4.7 months), (b) return-to-work consultations (40% versus 17% at 6 months), and (c) telephone support (42% versus 15% at 6 months). Each additional service (except prenatal education) dose-dependently increased exclusively breastfeeding at 6 months. Sociodemographic information including older maternal age, working part-time, longer maternity leave, and white ethnicity were associated with longer breastfeeding duration. Conclusion Workplace lactation interventions increased breastfeeding initiation, duration, and exclusive breastfeeding, with greater changes observed with more available services. More evidence is needed on the impact of workplace support in low-income populations, and the cost-effectiveness of these programs in reducing health care costs.

Home Visiting Effects on Breastfeeding and Bedsharing in a Low-Income Sample

2020 ◽  
pp. 109019812096419
Author(s):  
Joshua P. Mersky ◽  
Colleen E. Janczewski ◽  
ChienTi Plummer Lee ◽  
Ross M. Gilbert ◽  
Cali McAtee ◽  
...  
Keyword(s):  
Low Income ◽  
Home Visiting ◽  
Health Department ◽  
The United States ◽  
Breastfeeding Duration ◽  
Breastfeeding Initiation ◽  
Public Health Department ◽  
Safe Sleep ◽  
Quasi Experimental ◽  
The Impact

Background Research suggests that home visiting interventions can promote breastfeeding initiation, though their effects on breastfeeding continuation are unclear. No known studies have assessed the impact of home visiting on bedsharing. Aims To test the effects of home visiting on breastfeeding and bedsharing in a low-income, urban sample in the United States. Methods During a field trial conducted in Milwaukee, Wisconsin, from April 2014 to March 2017, referrals to a public health department were randomized to a Healthy Families America (HFA) program or a prenatal care and coordination (PNCC) program. Of the 204 women who accepted services, 139 consented to the study and were allocated to the two treatment groups, which were compared with each other and a third quasi-experimental group of 100 women who did not accept services. Data were collected at four time points up to 12 months postpartum. Results Breastfeeding initiation was higher among 72 HFA participants (88.4%; odds ratio [OR] = 2.7) and 67 PNCC participants (88.5%; OR = 2.2) than 100 comparison participants (76.5%). Similar results emerged for breastfeeding duration, though group differences were not statistically significant. Unexpectedly, bedsharing prevalence was higher among HFA participants (56.5%) than PNCC participants (31.1%; OR = 2.9) and comparison group participants (38.8%; OR = 2.0). Discussion Home visiting was linked to increased breastfeeding, while effects on bedsharing varied by program. Progress toward precision home visiting will be advanced by identifying program components that promote breastfeeding and safe sleep. Conclusion Further research is needed to examine whether home visiting reduces disparities in breastfeeding and safe sleep practices.

scholarly journals Promoting Breastfeeding at the Start: Hospital Practices and Breastfeeding Initiation and Exclusivity Among Low-income Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 782-782
Author(s):  
Susana Matias ◽  
Laurel Moffat ◽  
Kelsey MacCuish
Keyword(s):  
Low Income ◽  
Race And Ethnicity ◽  
Secondary Analysis ◽  
Policy Support ◽  
Breastfeeding Initiation ◽  
Breastfeeding Support ◽  
Birth Mothers ◽  
Nationally Representative ◽  
Survey Weighting ◽  
Hospital Practices

Abstract Objectives To determine whether hospital breastfeeding-related practices are associated with breastfeeding initiation (BF) and exclusive breastfeeding (EBF) at discharge in a low-income population. Methods This is a secondary analysis of the Infant Toddler Feeding Practices Study II (ITFPS-2), a nationally representative sample of low-income mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). This analysis included birth mothers who delivered at a hospital, whose infants did not spent time in the NICU, and had survey weighting data. BF and EBF (in women who initiated breastfeeding), hospital practices (rooming in, breastfeeding encouragement from staff, availability of staff who provided breastfeeding support, reception of gift pack, and among those who initiated breastfeeding, breastfeeding in the first hour and on demand, ) and sociodemographic data were collected via interview at 1 month postpartum. Logistic regression analysis, adjusting for maternal age, race and ethnicity, income, breastfeeding history, and delivery type, was conducted. We further adjusted for breastfeeding intentions, assessed in a sub-sample during pregnancy. Results The weighted analytic sample included 394,022 women (n = 311,355 for EBF). Rooming in was positively associated with BF (P < 0.0001). Among those who initiated breastfeeding, doing so within the first hour was associated with EBF (P < 0.0001). Breastfeeding encouragement from staff and availability of breastfeeding support staff were strongly associated with BF (both P < 0.0001), but not with EBF (P = 0.74 and P = 0.08, respectively). Receiving a pro-formula gift pack was associated with a 40% and 50% reduction in the odds of BF and EBF, respectively (both P < 0.0001). Further adjustment for breastfeeding intentions in a sub-sample (n = 250,665 for BF, n = 202,412 for EBF) provided similar findings. Conclusions Hospital practices were associated with breastfeeding practices, regardless of breastfeeding intentions. Limiting pro-formula gifts and providing breastfeeding support at hospitals, either directly or by creating an environment that allows for breastfeeding opportunities, may improve breastfeeding rates in the WIC population. Funding Sources The WIC ITFPS-2 is a federal study conducted under the direction of Office of Policy Support in the USDA FNS.

scholarly journals Trends in breastfeeding practices and mothers’ experience in the French NutriNet-Santé cohort

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Frédéric Courtois ◽  
Sandrine Péneau ◽  
Benoît Salanave ◽  
Valentina A. Andreeva ◽  
Marie Françoise Roland-Cachera ◽  
...  
Keyword(s):  
Public Health ◽  
Census Data ◽  
Breastfeeding Duration ◽  
Breastfeeding Initiation ◽  
Breastfeeding Support ◽  
The Public ◽  
The Past ◽  
Breastfeeding Practices ◽  
Breastfeeding Education ◽  
Breastfeeding Cessation

Abstract Background France has one of the lowest rates in the world regarding breastfeeding initiation and duration. Few studies have explored breastfeeding practices in France since the middle of the twentieth century, or following from initiation to cessation. The purpose of our study was to determine trends in breastfeeding over the past decades regarding public health recommendations, and to examine mothers’ perceptions about factors known to have an impact on breastfeeding support and cessation. Methods From the NutriNet-Santé cohort, 29,953 parous women (launched in 2009 to study relation between nutrition and health), were included in the present study. Using web-questionnaires, they were asked retrospectively if they had breastfed their youngest child or not, and if so, the duration of exclusive and total breastfeeding. For those who had breastfed, we investigated their perceptions about support at initiation and during the entire breastfeeding period and reasons for breastfeeding cessation. We also asked those who did not breastfeed about their perceptions and reasons for infant formula feeding their youngest child. Analyses were weighted according to the French census data. Results In the NutriNet-Santé cohort, 67.3% of mothers breastfed their youngest child. The proportion of breastfed children increased over the past few decades, from 55.0% (95% CI 54.3, 55.6) in the 1970s to 82.9% (82.4, 83.4) in the 2010s. Total and exclusive breastfeeding duration went from 3.3 months and 2.4 months respectively in the 1970s to 5.9 months and 3.2 months respectively in the 2010s. Most mothers felt supported at initiation and during the breastfeeding period. A reported desire to have breastfed longer than two months was 59.5%. Mothers who did not breastfeed did it by choice (64.3%). They did not feel guilty (78.2%) and did not perceive a problem not to breastfeed (58.8%), but almost half of them would have liked to have breastfed (45.9%). Conclusion Breastfeeding duration has increased in the past decades but did not reach the public health recommendations threshold. Targets other than mothers have to be considered for breastfeeding education, like the partner and her environment, to increase breastfeeding practices. Trial registration The study was registered at ClinicalTrials.gov (NCT03335644).

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

2021 ◽  
pp. 089033442110087
Author(s):  
Casey Rosen-Carole ◽  
Jill Halterman ◽  
Constance D. Baldwin ◽  
Hayley Martin ◽  
Nicolas P. N. Goldstein ◽  
...  
Keyword(s):  
New York ◽  
Breastfeeding Initiation ◽  
Provider Education ◽  
Breastfeeding Support ◽  
Post Intervention ◽  
Peer Counselors ◽  
Breastfeeding Intention ◽  
Healthy People 2020 ◽  
Peer Counselor ◽  
Publicly Insured

Background Breastfeeding rates for United States women with lower incomes fall below the government’s Healthy People 2020 Goals. Breastfeeding recommendations combined with support from providers and peer counselors help women decide to begin and sustain breastfeeding, but peer counselor uptake is low. Research Aim To evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention. Method In this pre-post intervention study (2015–2016; upstate New York), providers implemented a Toolkit to discuss infant feeding recommendations and initiate peer counselor referral. We surveyed women pre- and post-implementation (after delivery; 1 month postpartum) about prenatal breastfeeding intentions, provider support, and breastfeeding outcomes. Analyses controlled for secular trends. Results Pre-intervention ( n = 71) and post-intervention ( n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding support. Conclusions Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

Lactation Consultants’ Perceived Barriers to Providing Professional Breastfeeding Support

2017 ◽  
Vol 34 (1) ◽  
pp. 51-67 ◽  
Author(s):  
Erica H. Anstey ◽  
Martha Coulter ◽  
Cecilia M. Jevitt ◽  
Kay M. Perrin ◽  
Sharon Dabrow ◽  
...  
Keyword(s):  
Interdisciplinary Collaboration ◽  
Methodological Approach ◽  
Healthcare Providers ◽  
The United States ◽  
Perceived Barriers ◽  
Breastfeeding Initiation ◽  
Breastfeeding Support ◽  
Lactation Consultants ◽  
Suboptimal Breastfeeding ◽  
Breastfeeding Problems

Background: Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants’ perceived barriers to managing early breastfeeding problems. Methods: This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. Results: A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother’s self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. Conclusion: Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.

scholarly journals A Geospatial Analysis of the Impact of the Baby-Friendly Hospital Initiative on Breastfeeding Initiation in North Carolina

2018 ◽  
Vol 35 (1) ◽  
pp. 114-126 ◽  
Author(s):  
Abigail L. Liberty ◽  
Kathryn Wouk ◽  
Ellen Chetwynd ◽  
Tamar Ringel-Kulka
Keyword(s):  
North Carolina ◽  
Rural Areas ◽  
Secondary Analysis ◽  
Birth Certificate ◽  
Breastfeeding Initiation ◽  
Baby Friendly Hospital Initiative ◽  
Breastfeeding Support ◽  
Rural And Urban ◽  
Model Residuals ◽  
The Impact

Background: Significant disparities in breastfeeding support and practice exist in North Carolina. The Baby-Friendly Hospital Initiative is a worldwide intervention that encourages birth facilities to adopt specific practices in support of breastfeeding. Research aim: This study aimed to evaluate the impact of the Baby-Friendly Hospital Initiative on breastfeeding initiation in North Carolina, with special attention to rural areas. Methods: To better understand disparities in breastfeeding initiation across North Carolina, we conducted a secondary analysis of birth certificate data from 2011 to 2014. Univariate and multivariate logistic regression models were used to estimate the association between breastfeeding initiation and (a) birth at a Baby-Friendly hospital and (b) maternal residence in a county with a Baby-Friendly hospital. Model residuals were aggregated by county and analyzed for spatial autocorrelation. Results: Birth at a Baby-Friendly hospital was associated with increased odds of breastfeeding initiation, adjusted odds ratio = 1.7, 95% confidence interval [1.65, 1.89]. Model residuals showed significant clustering by county, with some rural areas’ rates systematically overestimated. Whereas presence of a Baby-Friendly hospital in a mother’s community of residence was not associated with increased initiation, birth at a Baby-Friendly hospital was associated with smaller disparities in initiation between rural and urban births. Conclusion: Birth at a Baby-Friendly hospital is associated with improved breastfeeding initiation and reduced disparities in initiation between rural and urban counties in North Carolina.

SEX DIFFERENCES IN THE SOCIAL ECOLOGY OF BREASTFEEDING: A MIXED METHODS ANALYSIS OF THE BREASTFEEDING VIEWS OF EXPECTANT MOTHERS AND FATHERS IN THE US EXPOSED TO ADVERSITY

2018 ◽  
Vol 51 (3) ◽  
pp. 374-393
Author(s):  
Carolyn J. Dayton ◽  
Angela Johnson ◽  
Laurel M. Hicks ◽  
Jessica Goletz ◽  
Suzanne Brown ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Infant Feeding ◽  
Low Income ◽  
Breastfeeding Initiation ◽  
Quantitative Methodology ◽  
Breastfeeding Support ◽  
Mothers And Fathers ◽  
Race Disparities ◽  
The Us ◽  
Expectant Mothers

AbstractDespite the significant health benefits of breastfeeding for the mother and the infant, economic class and race disparities in breastfeeding rates persist. Support for breastfeeding from the father of the infant is associated with higher rates of breastfeeding initiation. However, little is known about the factors that may promote or deter father support of breastfeeding, especially in fathers exposed to contextual adversity such as poverty and violence. Using a mixed methods approach, the primary aims of the current work were to (1) elicit, using qualitative methodology, the worries, barriers and promotive factors for breastfeeding that expectant mothers and fathers identify as they prepare to parent a new infant, and (2) to examine factors that influence the parental breastfeeding intentions of both mothers and fathers using quantitative methodology. A sample (N=95) of expectant, third trimester mothers and fathers living in a low-income, urban environment in Midwestern USA, were interviewed from October 2013 to February 2015 about their infant feeding intentions. Compared with fathers, mothers more often identified the benefits of breastfeeding for the infant’s health and the economic advantage of breastfeeding. Mothers also identified more personal and community breastfeeding support resources. Fathers viewed their own support of breastfeeding as important but expressed a lack of knowledge about the breastfeeding process and often excluded themselves from discussions about infant feeding. The results point to important targets for interventions that aim to increase breastfeeding initiation rates in vulnerable populations in the US by increasing father support for breastfeeding.

scholarly journals High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Deborah Winders Davis ◽  
W. David Lohr ◽  
Yana Feygin ◽  
Liza Creel ◽  
Kahir Jawad ◽  
...  
Keyword(s):  
Foster Care ◽  
Low Income ◽  
Secondary Analysis ◽  
The United States ◽  
Prescribing Patterns ◽  
Cross Sectional ◽  
Children In Foster Care ◽  
Metabolic Monitoring ◽  
Concurrent Use ◽  
High Level

Abstract Background The use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits. Methods A cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration. Results High-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015–2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate. Conclusions Concerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.

scholarly journals Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Elizabeth C Rhodes ◽  
Grace Damio ◽  
Helen Wilde LaPlant ◽  
Walter Trymbulak ◽  
Carrianne Crummett ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Role Models ◽  
The United States ◽  
Determinants Of Health ◽  
Breastfeeding Initiation ◽  
Program Model ◽  
Breastfeeding Support ◽  
Intensive Training ◽  
Peer Counselors

Abstract Background In the United States, Black and Hispanic mothers have lower breastfeeding rates compared with White mothers. To address breastfeeding inequities, the Breastfeeding Heritage and Pride program (BHP) provides breastfeeding support for predominately low-income minority mothers in Connecticut and Massachusetts. We described the process of designing BHP, the program model, and its impact on breastfeeding outcomes. Methods This BHP case study is based on in-depth interviews with BHP designers and implementers, peer counselors, and clients; a literature review of BHP impact evaluation studies; and a review of BHP materials. To guide the analysis and organize results, we used the Community Energy Balance Framework, an equity-oriented, multi-level framework for fostering healthy lifestyles. Results The Hispanic Health Council designed BHP to address barriers to breastfeeding identified through formative qualitative research with the Latino community, namely lack of role models, limited social support, embarrassment when breastfeeding in public, lack of breastfeeding knowledge, and a norm of formula feeding. According to the BHP model, clients receive education and support through in-person home and hospital visits supplemented by phone calls, beginning prenatally and continuing through one year postpartum. Counseling is delivered by peer counselors, women who have successfully breastfed, have similar cultural roots and life experiences as the clients they serve, and have completed intensive training on lactation management and communication skills. International Board Certified Lactation Consultants provide clinical guidance and ongoing training to peer counselors, as well as direct support to clients, if more specialized knowledge and clinical expertise is needed. Clients facing housing and food insecurity or other socio-economic obstacles that may negatively influence breastfeeding and health and well-being more broadly are connected to other health and social services needed to address their social determinants of health needs, including health care access and food and rent assistance programs. To continuously improve service delivery, BHP has a robust monitoring and evaluation system. In two randomized-controlled trials, BHP was shown to improve breastfeeding initiation and duration of any and exclusive breastfeeding. Conclusions BHP highlights the importance of community-engaged formative research for informing breastfeeding program design. It also provides an evidence-based example of a program model that offers a continuum of breastfeeding support, considers cultural-contextual influences on breastfeeding and social determinants of health, and incorporates continuous quality improvement.

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