Document Detail


Clinician support and psychosocial risk factors associated with breastfeeding discontinuation.
MedLine Citation:
PMID:  12837875     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Breastfeeding rates fall short of goals set in Healthy People 2010 and other national recommendations. The current, national breastfeeding continuation rate of 29% at 6 months lags behind the Healthy People 2010 goal of 50%. The objective of this study was to evaluate associations between breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support, maternal physical and mental health status, workplace issues, and other factors amenable to intervention. METHODS: A prospective cohort study was conducted of low-risk mothers and infants who were in a health maintenance organization and enrolled in a randomized, controlled trial of home visits. Mothers were interviewed in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks. Logistic regression modeling was performed to assess the independent effects of the predictors of interest, adjusting for sociodemographic and other confounding variables. RESULTS: Of the 1163 mother-newborn pairs in the cohort, 1007 (87%) initiated breastfeeding, 872 (75%) were breastfeeding at the 2-week interview, and 646 (55%) were breastfeeding at the 12-week interview. In the final multivariate models, breastfeeding discontinuation at 2 weeks was associated with lack of confidence in ability to breastfeed at the 1- to 2-day interview (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.02-7.6), early breastfeeding problems (OR: 1.5; 95% CI: 1.1-1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1-5.7), and lower maternal education (OR: 1.5; 95% CI: 1.2-1.9). Mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported (during the 12-week interview) having received encouragement from their clinician to breastfeed (OR: 0.6; 95% CI: 0.4-0.8). Breastfeeding discontinuation at 12 weeks was also associated with demographic factors and maternal depressive symptoms (OR: 1.18; 95% CI: 1.01-1.37) and returning to work or school by 12 weeks postpartum (OR: 2.4; 95% CI: 1.8-3.3). CONCLUSIONS: Our results indicate that support from clinicians and maternal depressive symptoms are associated with breastfeeding duration. Attention to these issues may help to promote breastfeeding continuation among mothers who initiate. Policies to enhance scheduling flexibility and privacy for breastfeeding mothers at work or school may also be important, given the elevated risk of discontinuation associated with return to work or school.
Authors:
Elsie M Taveras; Angela M Capra; Paula A Braveman; Nancy G Jensvold; Gabriel J Escobar; Tracy A Lieu
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pediatrics     Volume:  112     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-02     Completed Date:  2003-12-18     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  108-15     Citation Subset:  AIM; IM    
Affiliation:
Harvard Pediatric Health Services Research Fellowship Program, Children's Hospital of Boston, Boston, Massachusetts 02115, USA. elsie.taveras@tch.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Breast Feeding / psychology*,  statistics & numerical data
California
Cohort Studies
Depression, Postpartum / psychology
Education
Employment
Ethnic Groups
Female
Health Maintenance Organizations / statistics & numerical data
Health Promotion* / statistics & numerical data
Humans
Infant
Infant, Newborn
Maternal Age
Mothers / psychology*
Nurse-Patient Relations
Physician-Patient Relations*
Postpartum Period / psychology
Prospective Studies
Risk Factors
Social Support
Socioeconomic Factors
Weaning*
Grant Support
ID/Acronym/Agency:
6 H 16 MC 00050//PHS HHS; MCJ 067951//PHS HHS; T32 PE 10018/PE/BHP HRSA HHS

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