Success of a Lactation Education Program on NICU Nurses' Knowledge and Attitudes

Objectives: To test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support.
Design: Quasi-experimental, time-series pretest/posttest.
Setting: NICU of a Midwestern, free-standing, tertiary-care children's hospital.
Participants: Convenience sample of 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU ( n =19 and 13, respectively).
Methods: Nurses were measured on study outcomes at multiple time points, beginning with 2 weeks before and ending at 3 months after attendance to a 4-hour educational program. Mothers were sampled before and 3 months after the intervention.
Main Outcome Measure(s): Nurses' lactation knowledge, attitudes, beliefs, and intentions to support lactation and mothers' perceptions of lactation support in the NICU.
Results: Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses.
Conclusion: Intermittent, short educational programs which include practical how-to's and motivational encouragement for staff may provide the empowerment nurses need in order to be supportive of lactation.     

Maternal Practice and Attitudes Toward Breastfeeding

An age-graded sample of 411 New York City mothers is assessed to evaluate the direction and amount of change in incidence of breastfeeding. Social and demographic factors are considered and are found to have little trend effect. This limited sample fails to indicate any increase in breastfeeding in the 1970s, as compared to earlier decades. However, maternal attitudes are more positive toward breastfeeding than toward bottlefeeding; and some ethnic, economic, and sociocultural factors do affect decision to breastfeed.     

Maternity Nurses' Knowledge of Factors Promoting Successful Breastfeeding

An investigator-designed questionnaire was used to survey 53 RNs and LPNs at two urban hospitals concerning knowledge far support of breastfeeding mothers. Maternity nurses demonstrated limited knowledge, especially in drugs, maternal emotions, and neonatal physiology as related to breastfeeding. Level of education affected test scores positively; length of experience affected test scores negatively.     

The Effect of Prenatal Breastfeeding Education on Breastfeeding Success and Maternal Perception of the Infant

A quasi-experimental design was used to determine the effect of prenatal breastfeeding education on maternal reports of success in breastfeeding and maternal perception of the infant. The sample consisted of 40 primiparous women who desired to breastfeed their infants. All subjects were enrolled to attend childbirth education classes and vaginally delivered full-term, healthy infants without complication. Twenty subjects attended a prenatal breastfeeding education class and 20 served as controls. Data revealed that primiparous women who received prenatal breastfeeding education reported a significantly higher frequency of success in breastfeeding than those who did not ( P = 0.01). There was a significant difference in the Neonatal Perception Inventory (NPI) I scores of experimental and control subjects at one to two days postpartum ( P = 0.05). The NPI II scores of the experimental mothers were significantly more positive at one month postpartum ( P = 0.001). Primiparous women who received prenatal breastfeeding education reported significantly more positive NPI II scores than the control group ( P = 0.001).     

Knowledge and Attitudes Toward Breastfeeding in an African American Male Population

ObjectiveTo measure knowledge and attitudes toward breastfeeding among African American men.DesignCross‐sectional survey.SettingThree barbershops in Dallas, Texas.ParticipantsAfrican American adult men (N = 81).MethodsSurveys were completed by African American men to evaluate their knowledge, attitudes, and involvement in breastfeeding.ResultsOne half of the participants were age 26 to 40. Eighty‐five percent were U.S.‐born, and others were born in several African countries. Education varied from some high school to postgraduate. Most had some college or a degree (78%). One half were fathers (51%), and most were single (61%). Most had witnessed breastfeeding (85%), and 58% preferred their infants to be breastfed. Only 47% knew that breastfeeding helps prevent infant infections, and 15% knew it can prevent breast cancer in the mother. Significant differences were found when comparing knowledge and attitudes by place of birth and age. Almost one half of men age 18 to 25 (43%) and age 25 to 40 (48%) felt that breastfeeding should not occur in public compared to only 4% of men older than 40 (p = .005).ConclusionOverall, we found that African American men were supportive of breastfeeding, knew that breastfeeding was best for infants, and had positive attitudes toward breastfeeding. However, we found consistent gaps in knowledge about the actual health benefits to mothers and infants and conflicting attitudes toward breastfeeding. Results emphasize the need for health education efforts to improve attitudes toward breastfeeding in public.     

Influence of Knowledge and Attitudes on Exclusive Breastfeeding Practice Among Rural Jamaican Mothers

Abstract: Background : A large number of mothers may not be practicing exclusive breastfeeding in rural Jamaica, although no recent systematic study has been conducted. The impact of knowledge about and attitude toward breastfeeding on the duration of exclusive breastfeeding is also poorly understood. The objective of this study was to gather information about factors that influence exclusive breastfeeding and its duration. Method : A cross‐sectional study was conducted in 11 health centers within the parish of Saint Ann, Jamaica. A pretested questionnaire collected information on breastfeeding knowledge and attitudes toward intention to breastfeed and other relevant sociodemographic characteristics. Results : Information was documented for 599 mother‐child pairs. The prevalence of breastfeeding initiation was 98.2 percent; of mothers who initiated breastfeeding, 22.2 percent practiced it exclusively (at least 6 months). No difference occurred between exclusive and nonexclusive breastfeeding mothers in terms of knowledge about and attitudes toward breastfeeding. Of potential predictors assessed, the male partner's role as the main source of income for the family was the only significant predictor for exclusive breastfeeding. Women whose male partner was the main source of income for the family were twice as likely to exclusively breastfeed their infants compared with the referent group (mothers as main source of income)(OR = 2.0; 95% CI = 1.4–3.0). In addition, the dominant reason for partial breastfeeding was maternal anxiety that breastmilk alone might not provide sufficient nourishment. Conclusion : The level of exclusive breastfeeding was extremely low at the study site. Formulation of strategies to aggressively promote exclusive breastfeeding practices is urgently needed there. Such interventions should consider involvement of the male partner, especially, with respect to the financial support, as well as alleviating maternal anxiety regarding nutritional adequacy of breastmilk.     

Attitudes and Beliefs About Childbirth Among College Students: Results of an Educational Intervention

Background: Research on knowledge of childbirth has focused primarily on expectant mothers. The purpose of this study was to investigate college student beliefs, knowledge of, and interest in learning more about childbirth. Methods: Qualitative research methods were used to analyze college students' written responses to a childbirth video as the first stage in a research project aimed at understanding nulliparous and prepaternity knowledge of childbirth among adolescents and young adults. Participants were 65 students at a liberal arts college in upstate New York. Results: The findings demonstrated a range of levels of awareness, interest, and knowledge. In their responses, students described childbirth as a miraculous event associated with fear of pain; students primarily knew that childbirth takes place in the hospital, where “safe and effective” pain medication is administered; students liked seeing the experiential aspect of birth; and students wanted to know about the risks and benefits of various hospital procedures, and the “spiritual” emotional aspects of giving birth. Conclusion: The findings contribute insights into how college students think about pain in childbirth, suggesting that their fear is associated with a lack of knowledge. Teaching high school students specifics about pregnancy and childbirth practices and procedures holds promise for reducing anxiety, increasing maternal control, and supporting positive birth experiences.     

Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects on Breastfeeding,Temperature, and Crying

Background: Newborns not exposed to analgesia, when placed on the mother's chest, exhibit an inborn prefeeding behavior. This study was performed to assess the effects of different types of analgesia during labor on the development of spontaneous breastfeeding movements, crying behavior, and skin temperature during the first hours of life in healthy term newborns. Methods: Video recordings were made of 28 newborns who had been dried and placed in skin‐to‐skin contact between their mother's breasts immediately after delivery. The video recordings were analyzed blindly with respect to infant exposure to analgesia. Defined infant behaviors were assessed every 30 seconds. Group 1 mothers (n = 10) had received no analgesia during labor, group 2 mothers (n= 6) had received mepivacaine via pudendal block, and group 3 mothers (n= 12) had received pethidine or bupivacaine or more than one type of analgesia during labor. Results: All infants made finger and hand movements, but the infant's massagelike hand movements were less frequent in infants whose mothers had received labor analgesia. A significantly lower proportion of group 3 infants made hand‐to‐mouth movements (p < 0.001), and a significantly lower proportion of the infants in groups 2 and 3 touched the nipple with their hands before suckling (p < 0.01), made licking movements (p < 0.01), and sucked the breast (p < 0.01). Nearly one‐half of the infants, all in groups 2 or 3, did not breastfeed within the first 2.5 hour of life. The infants whose mothers had received analgesia during labor had higher temperatures (p= 0.03) and they cried more (p= 0.05) than infants whose mothers had not received any analgesia. Conclusions: The present data indicate that several types of analgesia given to the mother during labor may interfere with the newborn's spontaneous breast‐seeking and breastfeeding behaviors and increase the newborn's temperature and crying.     

Effect of Labor Analgesia on Breastfeeding Success

Background: The effect of labor analgesia on breastfeeding success is not well defined. Some authors have hypothesized that labor analgesia may affect lactation success. The purpose of this observational study was to determine if intrapartum analgesia influenced breastfeeding success at 6 weeks postpartum in a setting that strongly supported breastfeeding. Methods: Healthy women with uncomplicated term pregnancies who planned to breastfeed consented to a telephone interview. We recorded demographic data, labor induction status, delivery mode, and analgesic medications. At between 6 and 8 weeks postpartum, patients were asked to describe breastfeeding use, problems encountered, solutions derived, sources of support and information, and satisfaction. We created a logistic regression model using intrapartum analgesia information and controlling for demographic factors previously correlated with lactation success. Results: We enrolled 189 women, contacted 177 women postpartum, and obtained complete data on 171 women. Of these, 59 percent received epidural analgesia, 72 percent breastfed fully, and 20 percent breastfed partially (> 50% of infant nutrition) at 6 weeks postpartum. After controlling for demographics and labor outcome, we could not demonstrate a correlation between breastfeeding success at 6 to 8 weeks and labor analgesia. Conclusions: In a hospital that strongly promotes breastfeeding, epidural labor analgesia with local anesthetics and opioids does not impede breastfeeding success. We recommend that hospitals that find decreased lactation success in parturients receiving epidural analgesia reexamine their postdelivery care policies.     

Sucking Technique and Its Effect on Success of Breastfeeding

ABSTRACT: We investigated the prognostic value of sucking technique (faulty vs correct) during the first week after birth in relation to the long-term success of breastfeeding. At discharge from the maternity ward, 82 healthy mother-infant pairs were observed for assessment of breastfeeding technique and followed for four months by regular telephone checkups. Correct sucking technique was defined as the infant having a wide-open mouth, with the tongue under the areola, and expressing milk from the breast by slow, deep sucks; faulty technique was defined as superficial nipple sucking. The study population was divided into three groups: one in which faulty sucking technique was corrected when observed (n = 29), one with faulty but uncorrected technique (n = 25), and a control group with a correct technique (n = 28). At the four-month follow-up assessment, the faulty but uncorrected group was characterized by a greater proportion of mothers with breastfeeding problems and early cessation of breastfeeding than the other two groups. Regular use of a pacifier (>2 hrs/day) was more common among those with breastfeeding problems.     

Effects of an Educational Gynecological Exam on Women's Attitudes

A comparative evaluative survey using a non-experimental two-group before-and-after design was used to evaluate the gynecologic educational experience provided by an urban university student-health service family-planning staff during the student's first exam at that clinic. Analysis of the attitude scores found that the initial pre-exam attitudes of the two groups were different; there was a significant increase in the experimental group's positive feelings toward the speculum and internal exams; and the positive attitude changes were no longer significant at three months post-exam.     

Effects of Delayed Newborn Bathing on Breastfeeding,Hypothermia, and Hypoglycemia

ObjectiveTo determine whether delaying the newborn bath by 24 hours increases the prevalence of breastfeeding initiation and exclusive breastfeeding at discharge in healthy full-term and late preterm newborns (34 0/7–36 6/7 weeks gestation) and to examine the effect of delayed newborn bathing on the incidences of hypothermia and hypoglycemia.DesignPre–post implementation, retrospective, cohort study.SettingProvincial children’s hospital with an average of 2,500 births per year.ParticipantsHealthy newborns (N = 1,225) born at 34 0/7 weeks or more gestation who were admitted to the mother–baby unit.MethodsWe compared newborns who were bathed before 24 hours (n = 680, preimplementation group) to newborns who were bathed after 24 hours (n = 545, postimplementation group).ResultsAfter adjustment for confounders, the odds of exclusive breastfeeding at discharge were 33% greater in the postimplementation group than in the preimplementation group (adjusted odds ratio = 1.334; 95% confidence interval [1.049,1.698]; p = .019). Delayed bathing was associated with decreased incidence of hypothermia and hypoglycemia (p = .007 and p = .003, respectively). We observed no difference in breastfeeding initiation between groups.ConclusionDelaying the newborn bath for 24 hours was associated with an increased likelihood of exclusive breastfeeding at discharge and a decreased incidence of hypothermia and hypoglycemia in healthy newborns. The implementation of a delayed bathing policy has the potential to improve breastfeeding rates and reduce the incidence of hypothermia and hypoglycemia.     

Effect of a Brief Educational Intervention on the Attitudes of Young Women Toward the Intrauterine Device

Study ObjectiveThe intrauterine device (IUD) is underused by young women, who are at high risk for unintended pregnancy. We aimed to assess the impact of a brief educational intervention on the attitudes of young women toward intrauterine contraception and to assess characteristics associated with a change in attitude.Design, Setting, and ParticipantsThis is a planned secondary analysis of a survey of 144 women, aged 14–24 years, which assessed attitudes toward the IUD.InterventionThe analysis was planned to fully examine the impact of a 3-minute educational intervention about the IUD given during administration of the survey, which included risks and benefits of IUD use, costs, side effects, and a demonstration of the IUD insertion and removal process.Main Outcome MeasureProportions of participants with a positive attitude toward the IUD before and after the intervention were compared using McNemar's chi-square test for paired proportions. Factors associated with a change in attitude toward the IUD were evaluated using multivariable analysis.ResultsBefore the educational intervention, 14.7% (21/143) had both heard of the IUD and expressed a positive attitude toward it. After the intervention, this proportion increased to 53.8% (77/143) (P < .01). The increase in proportion with a positive attitude was consistent for all subpopulations. In multivariable analysis, the only significant predictor of a positive change in attitude toward the IUD was a history of voluntary sexual activity (adjusted odds ratio 10.3, 95% confidence interval 2.0–53.1).ConclusionsA brief educational intervention significantly improves the attitude of young sexually active women toward the IUD.     

Effect of Maternal Confidence on Breastfeeding Duration: An Application of Breastfeeding Self‐Efficacy Theory

ABSTRACT: Background: Although much research has focused on identifying factors that influence breastfeeding initiation and duration, many high‐risk factors are nonmodifiable demographic variables. Predisposing factors for low breastfeeding duration rates that are amenable to supportive interventions should be identified. The purpose of this study was to assess the effect of maternal confidence (breastfeeding self‐efficacy) on breastfeeding duration. Method: A prospective survey was conducted with 300 women in the last trimester of pregnancy recruited from the antenatal clinic of a large metropolitan hospital in Brisbane, Australia. Telephone interviews were conducted at 1week and 4 months postpartum to assess infant feeding methods and breastfeeding confidence using the Breastfeeding Self‐Efficacy Scale. Results: Although 92 percent of participants initiated breastfeeding, by 4 months postpartum almost 40 percent of mothers discontinued and only 28.6 percent were breastfeeding exclusively; the most common reason for discontinuation was insufficient milk supply. Antenatal and 1‐week Breastfeeding Self‐Efficacy Scale scores were significantly related to breastfeeding outcomes at 1 week and 4 months. Mothers with high breastfeeding self‐efficacy were significantly more likely to be breastfeeding, and doing so exclusively, at 1 week and 4 months postpartum than mothers with low breastfeeding self‐efficacy. Conclusions: Maternal breastfeeding self‐efficacy is a significant predictor of breastfeeding duration and level. Integrating self‐efficacy enhancing strategies may improve the quality of care that health care professionals deliver and may increase a new mother's confidence in her ability to breastfeed, and to persevere if she does encounter difficulties. (BIRTH 29:4 December 2002)     

Resident Physicians' Knowledge of Breastfeeding and Infant Growth

Background: It is well documented that breastfed infants grow differently from formula‐fed infants. The purpose of this study was to assess resident physicians' knowledge of breastfeeding and infant growth. Methods: A cross‐sectional, self‐administered survey was administered to family medicine and pediatric resident physicians from three large, hospital‐based public and private programs in North Carolina. Results: One hundred and seven (46%) of 235 residents completed the study, representing 55 percent of family medicine residents and 39 percent of pediatric residents. Ninety‐nine percent of participants reported frequently or always plotting infant growth at well‐child visits. None reported plotting breastfed babies on a chart specific to breastfeeding. Only 5 percent of participants knew that breastfed infants grew at a slower velocity than formula‐fed infants after 4 months of age. This knowledge was not significantly related to specialty, year of training, or gender; it was significantly related to breastfeeding experience (p < 0.04). Of the residents who did not have personal experience with breastfeeding, 99 percent answered incorrectly compared with 88 percent of those who had some personal experience in breastfeeding. Conclusions: In this sample of family medicine and pediatric residents, almost all were unaware that breastfed infants grow at slower rates after 4 months of age. Since the frequency of breastfeeding is increasing in the United States, it is important that physicians be able to monitor the growth of breastfed infants accurately and provide expert counseling for breastfeeding mothers.