Journal of Pediatric Health Care
January/February 2004 (Volume 18, Number 1)

Breastfeeding Knowledge and Practice of Pediatric Nurse Practitioners
Hellings P, Howe C
Journal of Pediatric Health Care. 2004;18(1):8-14

Given the recognized benefits of breastfeeding, and the unmet goal of the
US Department of Health and Human Services that 75% of infants be breastfed
at birth, it is important to assess how well NPs are doing in promotion of
this practice. The purpose of this study was to examine the attitude,
experiences, and knowledge of a group of pediatric nurse practitioners
(PNPs) and to compare the results with a sample of pediatricians, other
NPs, and nurse-midwives.

Results are based on a study tool sent to all 670 licensed family,
pediatric, women's health NPs and all nurse-midwives in the state of
Oregon; 405 individuals responded, including 77 PNPs, for a response rate
of 81%. All of the PNPs were women, and all but one was white. Nearly 75%
of the sample had breastfed their own children. More than 80% of the sample
had 5 or more years of experience as a PNP; 61% had been practicing for 10
or more years.

The respondents were asked about their educational preparation in the area
of breastfeeding. Answers were mixed. While a third of the audience had
never had the opportunity to observe a breastfeeding woman during their
education, another third had had this opportunity 5 or more times. Just
over a third had the opportunity to counsel an expectant mother about
feeding choices more than 5 times, while just under a third had never had
this opportunity. More than half of the sample had never had the
opportunity to counsel a woman in the use of a breast pump, and 40% had
never counseled women with breastfeeding problems such as cracked nipples
or mastitis.

Despite some of these gaps in education, more than 80% of the respondents
indicated that NP-program faculty were the most common source of
information about breastfeeding. However, these NPs also relied on the
expertise of lactation consultants and other educational opportunities such
as lectures, videos, and rounds.

PNPs overwhelmingly agreed that it was their role to recommend and promote
breastfeeding, and agreed with statements that nursing decreases the
incidence of otitis media and gastroenteritis and increases immune
function. A large majority of PNPs answered correctly, stating that
breastfeeding should not be discontinued in the case of mastitis or
maternal concerns about milk supply. They also agreed that they would not
recommend discontinuation of breastfeeding for infant teething, loose
stools, or perceived lack of satiety. Only regarding the presence of
maternal breast abscess did the PNPs' answers indicate a lack of knowledge,
with 35.5% unsure if they would recommend discontinuing nursing, and 9.2%
saying they would (incorrectly) recommend discontinuation.

Despite this strong support for nursing, 38.2% of PNPs reported that they
never counseled women about breastfeeding in their practices and 17.1%
never assisted mothers with breastfeeding technique. Just under a third of
respondents frequently counseled patients prenatally and assisted mothers
with breastfeeding technique and lactation problems.

The authors then compared results from this sample with those from a
pediatrician survey published in 1995. While a strong majority in both
samples were very supportive of breastfeeding, PNPs were more likely than
pediatricians to view breastfeeding as beneficial, be more aware of
evidence regarding benefits, and be more likely to correctly manage
breastfeeding problems. However, PNPs were somewhat less supportive of
breastfeeding than nurse-midwives. In addition, PNPs were less likely to
offer counseling to nursing mothers, including assisting with technique and
lactation problems.

It should be noted that this sample was not a nationally representative
one. In fact, more than half of the NPs had graduated from the home
institution of the coauthors, a program that routinely includes education
about breastfeeding in their curriculum. Thus, it cannot be presumed that a
national sample of NPs would be as supportive and knowledgeable about
breastfeeding. The implications for education are clear. Too many NPs rely
on their own personal experience, rather than their NP education, to guide
them in breastfeeding management.

Editor's Comment: I must admit to being wearied by the continuing chip-on-
the-shoulder tendency of NPs to compare our practice to physicians'
practice. However, once again, NPs have been shown to be on the right side
of the equation, with knowledge and skills that are equivalent or better
than that of physicians. Maybe someday we'll be able to dispense with the
necessity to keep proving it.

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html