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1.1 Discussing breastfeeding

Key Points - Case Study A

Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.

Would you discuss breastfeeding at this visit?
Topic 1.1: Discussing breastfeeding
It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.
Would you discuss breastfeeding at this visit?

Yes. While it is ultimately the mother who makes a decision regarding the method of infant feeding, she should make an informed decision with evidence-based information. Many women decide before or early in their pregnancy how they will feed their infant and the earlier they decide that they will breastfeed, the more likely they are to initiate and continue to breastfeed. 1 2

Intention to breastfeed,2,3,4 and intended length of breastfeeding 2 5 are the most powerful predictors of duration of breastfeeding. Additionally, there is a link between a doctor providing breastfeeding information, support and encouragement to women during the antenatal period and the rate of breastfeeding intention, 6
initiation 7 8 9 and duration. 8 10 11 Therefore, it is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born. 12

The positive influence of doctors and other health professionals on breastfeeding initiation and duration is only effective if there is overt support and encouragement. Neutrality is perceived by mothers as simply disguised indifference to how the baby is fed and has a similar effect on breastfeeding initiation and duration as overtly negative views. 9 13 14

Attending antenatal breastfeeding education classes, either as a separate class or as part of an antenatal education course, has also been shown to increase breastfeeding confidence, 15 initiation 16 17 and duration. 18 19 However, a recent Cochrane Systemic Review found that there was insufficient evidence to recommend one type of antenatal education over another. 20 The inclusion of specific segments on correct positioning and attachment of the baby at the breast reduces the incidence of nipple pain and trauma. 18 Providing women with a list of breastfeeding education opportunities in their local area, and encouraging them to participate, is recommended.

Notes

  1. # Hegney D et al. (2003) The Toowoomba infant feeding support service project: Report on phase1 - A longitudinal needs analysis of breastfeeding behaviours and supports in the Toowoomba region.
  2. # Scott JA et al. (2001) Factors associated with breastfeeding at discharge and duration of breastfeeding
  3. # Heath A-LM et al. (2002) A longitudinal study of breastfeeding and weaning practices during the first year of life in Dunedin, New Zealand
  4. # Colaizy TT et al. (2012) Maternal intention to breast-feed and breast-feeding outcomes in term and preterm infants: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003.
  5. # diGirolamo A et al. (2005) Intentions or experience? Predictors of continued breastfeeding
  6. # Kervin BE et al. (2010) Types and timing of breastfeeding support and its impact on mothers' behaviours.
  7. # Lu MC et al. (2001) Provider encouragement of breast-feeding: evidence from a national survey
  8. # Li L et al. (2004) Factors associated with the initiation and duration of breastfeeding by Chinese mothers in Perth, Western Australia
  9. # Bentley ME et al. (1999) Sources of influence on intention to breastfeed among African-American women at entry to WIC
  10. # Taveras EM et al. (2003) Clinician support and psychosocial risk factors associated with breastfeeding discontinuation
  11. # Utaka H et al. (2005) Breastfeeding experiences of Japanese women living in Perth, Australia
  12. # Brodribb W et al. (2007) Identifying predictors of the reasons women give for choosing to breastfeed.
  13. # DiGirolamo AM et al. (2003) Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions?
  14. # Brodribb WE et al. (2010) Attitudes to infant feeding decision-making - a mixed methods study of Australian medical students and GP registrars.
  15. # Kronborg H et al. (2012) Antenatal training to improve breast feeding: a randomised trial.
  16. # Deshpande AD et al. (2000) Breast-feeding education and support: association with the decision to breast-feed
  17. # Giugliani ER et al. (1994) Effect of breastfeeding support from different sources on mothers' decisions to breastfeed
  18. # Duffy EP et al. (1997) Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates.
  19. # Pugin E et al. (1996) Does prenatal breastfeeding skills group education increase the effectiveness of a comprehensive breastfeeding promotion program?
  20. # Lumbiganon P et al. (2012) Antenatal breastfeeding education for increasing breastfeeding duration.