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Maternity care experiences and breastfeeding at discharge among Maryland WIC participants: A qualitative analysis

Authors:
Marycatherine Augustyn
Marycatherine Augustyn
Marycatherine Augustyn
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Danielle Haskins
Danielle Haskins
Danielle Haskins
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Susan M Gross at Johns Hopkins Bloomberg School of Public Health
Susan M Gross
Amy Resnik at Maryland Department of Health
Amy Resnik
  • Maryland Department of Health
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Abstract

Background Breastfeeding imparts numerous health and social benefits for families. Barriers deter some individuals from breastfeeding. Rates are lower among certain populations, including participants of the federally funded Women, Infants, and Children's Program (WIC). Women, Infants, and Children's Program provides low‐income pregnant and postpartum women and children under 5 with nutrition education, supplemental foods, breastfeeding education and support, and resource linkages. Investigation of WIC participants' hospital experiences and breastfeeding decisions is limited. We explore qualitative themes associated with breastfeeding‐related hospital maternity care practices experienced by WIC participants. Methods Thirty pregnant individuals intending to breastfeed were recruited at WIC clinics to complete in‐depth interviews at 2 weeks, 3 months, and 6 months of postpartum. Using the Thematic Framework methodology, we analyzed data from the two‐week interviews of 29 participants with respect to hospital breastfeeding experiences. Results Fourteen participants were exclusively breastfeeding at discharge (EBFD). Fifteen were partially breastfeeding at discharge (PBFD). Differences between groups were found in hospital breastfeeding experiences, particularly in staff support. All participants EBFD reported positive breastfeeding‐related staff experiences. Most participants PBFD reported limited and ineffective staff interaction, leading to formula introduction. Conclusions Individuals EBFD and those PBFD reported about the same rate of hospital breastfeeding difficulties, yet half introduced formula within the first few days postpartum. Results reiterate the importance of hospital staff support to breastfeeding exclusivity at 2–3 days postpartum. The challenges that these individuals faced may have been resolved through available, responsive, and effective intervention. Data‐driven breastfeeding education programs for hospital health professionals are critical to affect patient breastfeeding outcomes.
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Birth. 2023;50:1009–1017. wileyonlinelibrary.com/journal/birt
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1009
© 2023 Wiley Periodicals LLC.
Received: 16 September 2021
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Revised: 18 April 2023
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Accepted: 20 July 2023
DOI: 10.1111/birt.12758
ORIGINAL ARTICLE
Maternity care experiences and breastfeeding at discharge
among Maryland WIC participants: A qualitative analysis
MarycatherineAugustyn PhD1
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DanielleHaskins MSPH1
|
SusanGross PhD, MPH, RD1
|
Amy KovarResnik MS, RD, LDN, IBCLC2
|
KirstieDucharme- Smith MS, RD, LDN3
|
DaniaOrta- Aleman MPH3
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JoAnneSilbert- Flagg RN, MSN, IBCLC4
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NadineRosenblum RN, MSN, IBCLC5,6
|
Laura E.Caulfield PhD3
1Department of Population, Family and
Reproductive Health, Johns Hopkins
University Bloomberg School of
Public Health (JHUBSPH), Baltimore,
Maryland, USA
2Maryland WIC Program, Maryland
Department of Health, Baltimore,
Maryland, USA
3Center for Human Nutrition, Johns
Hopkins University Bloomberg
School of Public Health (JHUBSPH),
Baltimore, Maryland, USA
4Pediatric Nurse Practitioner Track,
Johns Hopkins University School of
Nursing, Baltimore, Maryland, USA
5Department of Gynecology and
Obstetrics, Johns Hopkins Hospital,
Baltimore, Maryland, USA
6Adjunct Faculty, Johns Hopkins School
of Nursing, Baltimore, Maryland, USA
Correspondence
Marycatherine Augustyn, Department
of Population, Family and Reproductive
Health, Johns Hopkins University
Bloomberg School of Public Health
(JHUBSPH), 615 North Wolfe Street,
Room E4545, Baltimore, MD 21205-
2103, USA.
Email: maugust1@jhu.edu
Funding information
Health Resources and Services
Administration (HRSA), Grant/Award
Number: R40MC30762
Abstract
Background: Breastfeeding imparts numerous health and social benefits for
families. Barriers deter some individuals from breastfeeding. Rates are lower
among certain populations, including participants of the federally funded
Women, Infants, and Children's Program (WIC). Women, Infants, and Children's
Program provides low- income pregnant and postpartum women and children
under 5 with nutrition education, supplemental foods, breastfeeding education
and support, and resource linkages. Investigation of WIC participants' hospital
experiences and breastfeeding decisions is limited. We explore qualitative themes
associated with breastfeeding- related hospital maternity care practices experi-
enced by WIC participants.
Methods: Thirty pregnant individuals intending to breastfeed were recruited at
WIC clinics to complete in- depth interviews at 2 weeks, 3 months, and 6 months
of postpartum. Using the Thematic Framework methodology, we analyzed data
from the two- week interviews of 29 participants with respect to hospital breast-
feeding experiences.
Results: Fourteen participants were exclusively breastfeeding at discharge
(EBFD). Fifteen were partially breastfeeding at discharge (PBFD). Differences
between groups were found in hospital breastfeeding experiences, particularly in
staff support. All participants EBFD reported positive breastfeeding- related staff
experiences. Most participants PBFD reported limited and ineffective staff inter-
action, leading to formula introduction.
Conclusions: Individuals EBFD and those PBFD reported about the same rate
of hospital breastfeeding difficulties, yet half introduced formula within the first
few days postpartum. Results reiterate the importance of hospital staff support to
breastfeeding exclusivity at 2– 3 days postpartum. The challenges that these indi-
viduals faced may have been resolved through available, responsive, and effective
intervention. Data- driven breastfeeding education programs for hospital health
professionals are critical to affect patient breastfeeding outcomes.
ResearchGate has not been able to resolve any citations for this publication.
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For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. 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Article
  • Mar 2022
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Sudden Unexpected Infant Death (SUID) disproportionately affects non-Hispanic Black (NHB) and American Indian/Alaskan Native (AI/AN) infants, who have lower rates of breastfeeding than other groups. No existing literature investigates if breastfeeding explains disparities in SUID rates. Using 13,077,880 live birth certificates and 11,942 linked SUID death certificates from 2015-2018, we calculated odds ratios and adjusted risk differences (AdjRD) of SUID by not-breastfeeding across 5 racial/ethnic strata in the United States. We analyzed mediation by not-breastfeeding in the race/ethnicity-SUID association. The overall SUID rate was 0.91/1,000 live births. NHB and AI/AN infants had the highest disparity in SUID relative to non-Hispanic White (NHW) infants. Overall not-breastfeeding was associated with SUID, adjusted Odds Ratio (aOR) 1.14 (95% Confidence Interval [CI]: 1.10, 1.19), the AdjRD was 0.12/1,000 live births. The aOR of not-breastfeeding for SUID was 1.07 (95% CI: 1.00, 1.14) in NHB infants, and 1.29 (95% CI: 1.14, 1.46) in Hispanic infants. Breastfeeding minimally explained the higher SUID risk in NHB infants (2.3% mediated) and the lower risk in Hispanic infants (2.1% mediated) relative to NHW infants. Competing risks likely explain the lower aOR seen in NHB infants of not-breastfeeding on SUID, suggesting that social/structural determinants must be addressed to reduce racial disparities in SUID.
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