Carol A. Friesen

Breastfeeding Knowledge, Breastfeeding Confidence, and Infant Feeding Plans: Effects on Actual Feeding Practices

OBJECTIVE To explore relationships among breastfeeding knowledge, breastfeeding confidence, and infant feeding plans and their effects on feeding practices in first-time breastfeeding mothers. DESIGN Prospective descriptive design. SETTING Telephone interviews were conducted prenatally and at 6 weeks, 3 months, and 6 months postpartum. PARTICIPANTS Seventy-four of 83 first-time mothers with prenatal intentions to breastfeed completed all study requirements. The majority were White (95%), between the ages of 21 and 30 years (73%), with a post-high school education (85%), and household incomes of more than 200% of the federal poverty guideline (88%). MAIN OUTCOME MEASURES Breastfeeding knowledge, breastfeeding confidence, planned infant feeding method, planned breastfeeding duration, weeks of daily human milk substitute feeding, breastfeeding duration, achievement of breastfeeding goals. RESULTS Breastfeeding knowledge was strongly correlated with breastfeeding confidence (r = .262; p = .025) and actual lactation duration (r = .455; p = .0001). Compared with women planning to exclusively breastfeed their infants, those planning to combination feed planned shorter breastfeeding duration (p = .022), reported shorter actual duration (p = .004), and were less likely to meet their breastfeeding goal (p = .034). The variables maternal education, breastfeeding knowledge, and weeks of daily human milk substitute feeding were used to develop a prediction equation that correctly categorized 93% of participants who met their breastfeeding goal and 90% of those who did not. CONCLUSIONS Expectations and the actual breastfeeding experience differed among women planning to combination feed and those planning to exclusively breastfeed. Whether a cause or consequence, daily human milk substitute feeding was associated with negative breastfeeding outcomes.

Sources of Infant Feeding Information Used by Pregnant Women

Selecting an infant feeding method is one of the most important decisions a mother-to-be makes. Little information is available to characterize women who plan to use both formula and breast milk. In this study, 89 pregnant women indicated their anticipated feeding method and the sources and initiator of infant feeding information. No differences were found in the type of resources used by women who planned to breastfeed, formula feed, or combination feed. Women in the study were four times more likely to initiate a conversation about infant feeding methods with a family member or friend than with a health care provider. Involving these key individuals in perinatal education classes and support programs is a simple, but powerful, strategy that childbirth educators can use to promote breastfeeding.

Using Videoconferencing Technology to Provide Breastfeeding Support to Low-Income Women: Connecting Hospital-Based Lactation Consultants with Clients Receiving Care at a Community Health Center.

The Tele-Lactation Pilot Project (TLPP), 1 of 13 community-based breastfeeding projects implemented in Indiana in 2013 using Centers for Disease Control and Prevention grant funds, explored the feasibility of using videoconferencing technology to provide breastfeeding education and support to low-income women by a centrally located International Board Certified Lactation Consultant (IBCLC). The IBCLC was housed at the Breastfeeding Center at the hospital where the women would deliver; the women receiving the education and support were located at an inner-city community health center (CHC) where they received their primary care. The videoconferencing sessions were juxtaposed with the women’s regularly scheduled prenatal and postnatal visits at the CHC. After delivery, the lactation consultant visited the mother and infant in person at the hospital to offer additional support. Overall, 35 mothers were served by the TLPP during the 9-month project period. A total of 134 visits (30-45 minutes each) were conducted (3.8 sessions per woman). At the conclusion of the project, interviews with key participants indicated that the tele-lactation videoconferencing sessions were easy to implement, allowed the IBCLC to reach a wider client base, and allowed the women to receive expert support that they might not have otherwise received. Comments indicated that, in addition to providing education and increasing the women’s confidence, the tele-lactation sessions appeared to have decreased the mothers’ anxiety about the birthing process and the hospital experience. The TLPP demonstrated that incorporating videoconferencing technology into routine care can help foster collaboration among health care providers and provide mothers with continuous, easily accessible breastfeeding education and support.

The Impact of a Volunteer Postpartum Doula Program on Breastfeeding Success A Case Study

Bloomington Area Birth Services (BABS), centered in Bloomington, Indiana, is a community-based program that provides comprehensive education and support for new breastfeeding mothers, infants, family members, and the community by working together with local hospitals, midwives, obstetricians, pediatric offices, and social service agencies to create a seamless continuity of care for families. To help with continuity of care in the community, BABS established a volunteer doula program (birth and postpartum), allowing BABS to combine the services of a community lactation center with birth and postpartum doulas. This article describes the volunteer doula program and highlights one client’s story in an effort to encourage and motivate other communities to focus their limited dollars on the development of a volunteer doula program.

Breastfeeding Support in a Community Pharmacy Improving Access through the Well Babies at Walgreens Program

Well Babies at Walgreens is a unique community-based corporate partnership program that offers breastfeeding support by a lactation professional in a private room at the pharmacy. Walgreens is a community pharmacy chain with more than 8000 locations in the United States, Puerto Rico, and the US Virgin Islands. The primary goal of Well Babies is to support breastfeeding women using a model that is expandable to other Walgreens pharmacy sites. The Well Babies program offers drop-in services, with a professional consultation by a lactation consultant and baby weight check, if desired. Well Babies creators are developing a business plan for Walgreens and a toolkit that would help other stores implement the program. An additional goal is to improve continuity of care for breastfeeding by engaging pharmacists as vital members of the health care team. Offering breastfeeding support at a pharmacy improves access and encourages support persons to attend while simultaneously allowing the family to complete other errands. This initiative included education for pharmacists to improve the recommendations they make for breastfeeding mothers and to improve awareness among pharmacists of the benefits associated with breastfeeding and the need to preserve the breastfeeding relationship. The first drop-in location opened in April 2012. Grant funding from the US Centers for Disease Control and Prevention, awarded to the Indiana State Department of Health, made it possible to open a second drop-in location in June 2013. Future plans include developing an employee lactation program and expanding Well Babies at Walgreens at other store locations.

The Bosom Buddy Project: A Breastfeeding Support Group Sponsored by the Indiana Black Breastfeeding Coalition for Black and Minority Women in Indiana.

In 2012, the Indiana Black Breastfeeding Coalition (IBBC) used grant funds to increase participation in the Bosom Buddy Project, an original breastfeeding support group that pairs breastfeeding mothers with trained mentors. Resources for local organizations that support breastfeeding are extremely limited, making it difficult to expand programs and services. This article describes a variety of strategies used by the IBBC to expand programs and services. These activities provide a template for other community-based organizations that wish to provide culturally sensitive breastfeeding support in their community.

Community-Based Participatory Initiatives to Increase Breastfeeding Rates in Indiana

In 2012, the Centers for Disease Control and Prevention awarded the Indiana State Department of Health funding for breastfeeding activities. The grant, issued in part in response to the 2011 Surgeon General’s Call to Action to Support Breastfeeding, focused on providing funding and technical support to small community-based organizations to address challenges encountered by breastfeeding mothers. Indiana used the funds to develop the Community Breastfeeding Support Initiative (CBSI). The goal was to provide funding and technical support to small community-based organizations to carry out self-selected projects in their communities. The 13 CBSI programs served 1345 individual clients (n = 3664 visits) during the 9-month period. This article provides valuable information about collaboration at the state level and the supporting infrastructure in place to carry out this project. Our findings about the number of clients served, number of visits, community-specific programs and activities, and lessons learned can be used by other organizations as they plan breastfeeding support programs for their community.