Breastfeeding Rates at the Six-Week Postpartum Visit

Anita Bordoloi MD, Francesca Popper MD, Stephen Locher MDDepartment of Obstetrics and Gynecology, Advocate Illinois Masonic Medical Center

Breastfeeding Rates at the Six-Week Postpartum Visit

Anita Bordoloi MD, Francesca Popper MD, Stephen Locher MDDepartment of Obstetrics and Gynecology, Advocate Illinois Masonic Medical Center

Abstract:Introduction: Despite the evidence supporting the maternal and

neonatal benefits of breastfeeding, the rate of breastfeeding in the United States remains sub-optimal. The Healthy People 2010 project identified the goal of 75% breastfeeding rates in the early postpartum period. Our goal was to determine the breastfeeding rates at the six-week postpartum visit at the Obstetrics and Gynecology (OB-GYN) Faculty Group practice at Advocate Illinois Masonic Medical Center (AIMMC) and compare it to the overall breastfeeding rates for all patients discharged from the Mother-Baby unit at AIMMC in 2010.

Method: Of the 322 total patients from the OB-GYN Faculty Group practice who delivered in 2010 at AIMMC, a sample population of 47 randomly selected patients (15%) were chosen for retrospective chart review. Overall breastfeeding statistics for all postpartum patients discharged from the Mother-Baby Unit at AIMMC for 2010 (n=2215) were also reviewed and used to compare against the sample group.

Result: The breastfeeding rate at the six-week postpartum visit at the OB-GYN Faculty Group practice was 79%, with 51% of patients breastfeeding exclusively. This was comparable to the overall breastfeeding rate at discharge for all postpartum patients from AIMMC in 2010, which was also 79%. The percentage of patients exclusively breastfeeding at six weeks at this practice was higher than the overall rate of exclusive breastfeeding upon hospital discharge, which was only 35%. Additionally, the breastfeeding rate in the immediate postpartum period at this practice was found to be above the Healthy People 2010 goal of 75%.

Conclusion: Breastfeeding rates at the six-week postpartum visit at the OB-GYN Faculty Group practice at AIMMC are above the target set by Healthy People 2010. The six-week breastfeeding rate is comparable to the overall breastfeeding rates at hospital discharge from the Mother-Baby Unit at AIMMC in 2010. Also, the rate of exclusive breastfeeding is higher at this practice at six weeks compared to the overall AIMMC postpartum patient population at discharge.

Introduction:

The benefits of breastfeeding, both maternal and neonatal, have been widely studied and promoted in the United States. The American College of Obstetricians and Gynecologists “strongly supports breastfeeding”1 and the American Academy of Pediatrics officially states that “breastfeeding ensures the best possible health as well as the best developmental and psychosocial outcomes for the infant.”2 However, despite this knowledge, the rate and duration of breastfeeding in the United States remains sub-optimal. Data from the 2010 CDC Breastfeeding Report Card for 2010 showed that 75% of mothers had ever breastfed, 43% breastfed at six months and 22.4% breastfed at one year.3 This is addressed in the national initiative Healthy People 2010, which aims to increase the proportion of mothers who breastfeed their babies, with target rates of 75% in the early postpartum period, 50% at six months, and 25% at one year.4 Figure 1 displays the percentages of children breastfeeding at six months by state in 2007.

A retrospective chart review was performed of patients who came for a six-week postpartum visit at the OB-GYN Faculty Group practice at AIMMC in 2010. Medical records were reviewed for infant feeding practices, i.e. breastfeeding, bottlefeeding, or both. Breastfeeding statistics for all postpartum patients discharged from the Mother-Baby Unit at AIMMC for 2010 (n=2215) were obtained from the breastfeeding logbook kept by the lactation nurses on the unit.

Conclusions: Breastfeeding rates at the six-week postpartum visit at the OB-

GYN Faculty Group practice (79%) were comparable to breastfeeding rates at hospital discharge for all patients (79%).

Exclusive breastfeeding rates were higher amongst OB-GYN Faculty Group practice patients at six weeks postpartum (51%) versus all patients from the Mother-Baby Unit at hospital discharge (35%).

The findings of this study suggest that OB-GYN Faculty Practice patients are able to maintain breastfeeding in the immediate postpartum period between hospital discharge and the six-week postpartum visit and that they are more likely to exclusively breastfeed than the general postpartum patient population at AIMMC.

Overall breastfeeding rates at hospital discharge for all patients and at the six-week postpartum visit for OB-GYN Faculty Group patients were higher than the Healthy People 2010 goal of 75% of mothers breastfeeding in the immediate postpartum period.

Although the overall breastfeeding rates at hospital discharge and six-week postpartum visit exceed the goal of Healthy People 2010, they are still less than 100%, which suggests that some patients still encounter barriers to breastfeeding. Identifying those barriers could aid in improved interventions for increasing the breastfeeding rate at AIMMC.

Limitations of this study include low power and comparison between two different patient populations for breastfeeding rates at hospital discharge and at the six-week postpartum visit. A larger sample patient population would strengthen this study. Also, recording the obstetrical provider of discharged patients in the lactation logbook would allow for better comparisons because the same patient population could be used.

Future considerations for study could be a comparison of six-week postpartum breastfeeding rates amongst the different obstetrical services at AIMMC, e.g. OB-GYN Faculty Group patients versus OB-GYN resident clinic patients versus Certified Nurse-Midwife patients. The typical patient populations amongst these obstetrical services often differ from one another as far as education, socio-economic background and age and it would be interesting to see if these variables influence the breastfeeding rates at each practice.

References:

Results:

Figure 2. Overall and exclusive breastfeeding rates at hospital discharge (all patients) and at the six-week postpartum visit (OB-GYN Faculty Group patients) compared to Healthy People 2010 goal rate

Subjects

There were 322 total deliveries in 2010 for the OB-GYN Faculty Group. Of these, 47 patients’ charts were randomly selected for review, which represented a sample population of 15%. Selection criteria included any woman who had a vaginal delivery or cesarean section of a viable infant in 2010 and followed up for their six-week postpartum visit. Exclusion criteria included follow-up visits less than or greater than six weeks postpartum. Data privacy and protection were maintained at all times through use of a password-protected Microsoft Excel spreadsheet accessible only by the study investigators.

Methods:

Data Analysis

Descriptive statistics including frequencies were used to determine the overall and exclusive breastfeeding rates at hospital discharge and at the six-week postpartum visit.

Various studies have tried to identify factors that influence breastfeeding practices. It has been shown that increased rates and duration of breastfeeding are seen in women who are older, married, educated, from higher socio-economic backgrounds, less likely to be depressed, and have infants with normal weight and gestational age (Table 1).5

Table 1. Factors associated with increased rates and duration of breastfeeding

Older

Married

Educated

Higher socio-economic background

Not depressed

Infant with normal weight

Term infant

79% 79%

75%

35%

51%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

At Hospital Discharge At Six-Weeks Postpartum Healthy People 2010 Goal

Overall Breastfeeding Exclusively Breastfeeding

Out of 47 patients from the OB-GYN Faculty Practice who came for a six-week postpartum visit in 2010, 37 women were breastfeeding (79%, 37/47). Of those women, 24 were breastfeeding exclusively (51%, 24/47) and 13 were both breast and bottle-feeding (28%, 13/47). The remaining 10 patients bottle-feeding only (21%, 10/47). (Table 2)

Out of the 2215 patients who were discharged from the Mother-Baby Unit at AIMMC in 2010, 1751 women were breastfeeding (79%, 1751/2215). Of those women, 766 were breastfeeding exclusively (35%, 766/2215) and 985 were both breast and bottle-feeding (44%, 985/2215). The remaining 464 patients were bottle-feeding only (21%, 464/2215). (Table 3)

Findings and comparisons of the overall and exclusive breastfeeding rates at hospital discharge and six-week postpartum visit versus the Healthy People 2010 goal breastfeeding rate of 75% in the immediate postpartum period are summarized in Figure 2.

Figure 1. Percent of children who are breastfed at 6 months of age, among children born in 2007 (provisional)

SOURCE:National Immunization Survey, Centers for Disease Control and Prevention, Department of Health and Human Services.

Acknowledgements:

1. Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007 Feb;109(2 Pt 1):479-80.

2. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI; American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2005 Feb;115(2):496-506.

3. Centers for Disease and Control, Breastfeeding Report Card – United States, 2010. http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed March 13, 2011.

4. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.

5. Callen J, Pinelli J. Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review. Birth. 2004 Dec;31(4):285-92.

Image sources: http://images.emedicinehealth.com/images/4453/4453-4502-12156-61548.JPG, www.breastfeedingsymbol.org

The study investigators would like to acknowledge Elliot Levine, MD and Marilyn Fergus, RN, IBCLC, RLC for their assistance.

Table 2. Infant feeding practices at the six-week postpartum visit at the OB-GYN Faculty Practice (N=47)

Number of Patients

Percent of Total (%)

Breastfeeding (total) 37 79

Breastfeeding only 24 51

Breast and bottle-feeding 13 28

Bottle-feeding only 10 21

Table 3. Infant feeding practices at hospital discharge from the Mother-Baby Unit at AIMMC (N=2215)

Number of Patients

Percent of Total (%)

Breastfeeding (total) 1751 79

Breastfeeding only 766 35

Breast and bottle-feeding 985 44

Bottle-feeding only 464 21

The International Breastfeeding Symbol