Primary Care Protocol May Increase Exclusive Breast-feeding

Troy Brown

April 01, 2013

A breast-feeding-friendly clinical protocol used in a primary care setting may increase rates of exclusive (no formula) breast-feeding in infants up to 6 months of age, according to a retrospective before-and-after study of 757 mother–infant dyads.

Sharon K. Corriveau, DNP, RN, CFNP, IBCLC, a nurse practitioner and lactation consultant at Loudoun Pediatric Associates in Leesburg, Virginia, and colleagues published their findings in an article published online April 1 in Pediatrics.

The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months of age, with the addition of solid foods for the second 6 months. According to the Centers for Disease Control and Prevention, 76.9% of women initiate breast-feeding in the early postpartum period, but exclusivity and duration of breast-feeding decline quickly within a short time.

The study was conducted in a large pediatric practice with 2 clinics that serve multicultural urban and rural populations.

The researchers used the Academy of Breastfeeding Medicine clinical protocol ("The Breastfeeding-Friendly Physician's Office, Part 1: Optimizing Care for Infants and Children") as a template. The academy's protocol follows guidelines from the World Health Organization and United Nations Children's Fund Baby-Friendly Hospital Initiative.

The study protocol includes staff training, written policies, support from an on-site lactation consultant, community outreach, and data tracking.

The preintervention group included 376 mother–infant pairs, and the postintervention group included 381 mother–infant pairs. The investigators collected data during the hospital stay, the newborn visit, and the 2-, 4-, and 6-month health maintenance visits.

The postintervention protocol included training for the medical staff, as well as a monthly "meet and greet" session at the clinic for the community that included a discussion of breast-feeding services, including breast-feeding classes and a support group. For patients, the intervention began at the newborn visit, when a registered nurse who is also a lactation consultant mets with the mother–infant pair for up to 1 hour. All breast-feeding concerns are referred to the lactation consultant at subsequent visits, and lactation support is available as needed.

Exclusive breast-feeding rates were significantly higher in the postintervention group compared with the preintervention group at all 5 times (P < .01). Exclusive breast-feeding rates were at least 10 percentage points higher in the postintervention group at all 5 times. Rates for any breast-feeding were also higher in the postintervention group compared with in the preintervention group at every point, but these differences were significant only at the 1-week point (P = .021).

The proportion of primiparous mothers was higher in the postintervention group (53.8%) compared with the preintervention group (40.4%), and this increase was significant (P < .001).

The researchers conducted χ2 tests separately for primiparous and multiparous mothers to compare exclusive breast-feeding and any breast-feeding in both groups at all times. The results were similar to those of the combined parity groups, except at week 1, the exclusive breast-feeding rate for the multiparous mothers increased by only 9.6 percentage points, which was not statistically significant.

"The results from this study suggest that the use of a breastfeeding-friendly clinical protocol in the primary care setting may help increase exclusive (no formula) breastfeeding rates up to 6 months of age," the authors write.

"Further studies should explore use of this protocol, inclusive of patient populations and/or regions known to have low breastfeeding rates, to help expand its use and address this important public health initiative," the authors conclude.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online April 1, 2013. Abstract