PEDIATRICS Vol. 113 No. 4 April 2004, pp. e283-e290
	
Opinions and Practices of Clinicians Associated With Continuation of
Exclusive Breastfeeding 

Background. The American Academy of Pediatrics recommends exclusive
breastfeeding for the first 6 months of life. Recent statistics indicate
that initiation and maintenance of exclusive breastfeeding are low in
the United States. Unfortunately, little information is available on how
clinicians and health care organizations can best promote continuation
of exclusive breastfeeding. 

Objective. To identify clinicians' opinions and management practices
that are associated with continuation of exclusive breastfeeding. 

Methods. We conducted a prospective cohort study of low-risk
mother-newborn pairs in a large, multispecialty group practice in which
the mother was breastfeeding at 4 weeks. Mothers completed telephone
interviews at 4 and 12 weeks postpartum, and their data were linked with
their obstetric and pediatric clinicians' responses to a cross-sectional
mailed survey conducted during the same time period. Obstetric and
pediatric clinicians included medical doctors, nurse practitioners, and
nurse midwives. Overall response rates were 63% for mothers and 82% for
clinicians (54 obstetric and 67 pediatric clinicians). Bivariate and
multivariate analyses were conducted to identify the characteristics of
clinicians and mothers that predicted exclusive breastfeeding at 12
weeks. 

Results. Of the 288 mothers who were breastfeeding at 4 weeks and had a
complete 12-week interview, 152 (53%) were exclusively breastfeeding
their infants at 12 weeks. Mothers who discontinued exclusive
breastfeeding were more likely to have experienced problems with their
infant latching on or sucking (odds ratio [OR]: 3.8; 95% confidence
interval [CI]: 1.5-9.7) or report that a health care provider
recommended formula supplementation (OR: 2.3; 95% CI: 1.1-5.0). 

Clinicians reported limited time during preventive visits to address
breastfeeding problems as a very important barrier to promoting
breastfeeding. Obstetric providers were least confident in resolving
problems with mothers not producing enough breast milk. Pediatric
providers were least confident in resolving problems with breast pain or
tenderness or cracked or painful nipples. 

In the final multivariate model, mothers whose pediatric providers
recommended formula supplementation if an infant was not gaining enough
weight (OR: 3.2; 95% CI: 1.04, 9.7) or who considered their advice to
mothers on breastfeeding duration to be not very important (OR: 2.2; 95%
CI: 1.2-3.9) were more likely to have discontinued exclusive
breastfeeding by 12 weeks postpartum. Black mothers were significantly
more likely to discontinue exclusive breastfeeding by 12 weeks. 

Conclusions. Clinicians' practices regarding formula supplementation of
healthy infants and their opinions about the importance of their
breastfeeding advice are associated with the likelihood that mothers
will continue exclusive breastfeeding. Policies to enhance clinicians'
abilities to address breastfeeding problems within the constraints of
busy practices could improve their ability to support exclusive
breastfeeding. 


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