Evaluating the impact of provider breastfeeding encouragement timing: Evidence from a large population-based study

Abstract

Background: Exclusive breastfeeding is the healthiest and most economical form of infant nutrition. Although research hasindicated that professional support increases the length of time women breastfeed, the optimal timing of provider encouragementto sustain mothers’ breastfeeding is unknown. We evaluated the impact of the timing of provider encouragement on breastfeedinginitiation and three-month duration, especially among racial/ethnic minority mothers who have been underrepresented inbreastfeeding outcomes research. Methods: We used data from the 2010 Los Angeles Mommy and Baby (LAMB) Survey. LAMB is a population-based mailsurvey, distributed to women in Los Angeles County who recently gave birth to a live infant. Participants were asked abouttheir perceptions of provider encouragement of breastfeeding at three specific time points: during prenatal care visits, during thebirth hospital stay after the baby was born, and during early well-baby checkups. Mothers were asked whether they breastfed orpumped breast milk to feed their baby after delivery and if they were still breastfeeding at the time of the survey. Results: Overall, 87.6% of LA County mothers initiated breastfeeding after delivery. At 3 months, 60% were still breastfeeding.Adjusted logistic regression analysis showed a positive association between provider encouragement at the delivery hospitaland breastfeeding initiation (aOR = 2.7, 95% CI = 1.60-3.96) that was significant across all races/ethnicity. Encouragementduring well-baby checkups was positively associated with breastfeeding at 3 months (aOR = 1.5, 95% CI = 1.22-1.93). Thislatter association was found among all races and ethnicities, except for Black mothers. There was no association betweenencouragement provided during prenatal care and breastfeeding practices. Conclusions: The optimal timing of provider encouragement on breastfeeding initiation is likely during the birth hospitalization,while sustained breastfeeding likely requires professional support after discharge. Culturally appropriate interventions to maintainpositive breastfeeding practices must be identified, especially for black mothers.