Educating Physicians about Breastfeeding: Building a Foundation

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Educating Physicians about Breastfeeding
Building a Foundation

• Lori Feldman-Winter, MD, MPH
• Associate Professor of Pediatrics
• Childrens Regional Hospital at Cooper
• UMDNJ-RWJMS

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Disclosure

• I have no relevant financial relationships with
  the manufacturers(s) of any commercial
  products(s) and/or provider of commercial
  services discussed in this CME activity.
• I do not intend to discuss an unapproved/investiga
  tive use of a commercial product/device in my
  presentation.

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Thank You!
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Outline

• Breastfeeding Matters
• Evidence that physicians need education
• Why physicians matter in breastfeeding promotion
• Promising strategies
• What physicians can/should do

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Learning Objective

• Understand the critical importance of
  physicians in providing consistent and positive
  breastfeeding advocacy and support, and be
  familiar with initiatives in resident training

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Breastfeeding Matters Top 10AHRQ Evidence Based
Review

• AOM 50 less EBFgt3-6 months
• Atopic Dermatitis less 42 EBFgt3 months
• Gastro less 64 with any BF vs. none
• LRTI and hospitalization less 72 with EBFgt4
  months
• Asthma less 40 for BFgt3 months
• Obesity less 4-24

• T1DM less 19-27 BFgt3 months
• T2DM less 39 with any BF vs. none
• Cancer
• ALL less 19 with BFgt6 months
• AML less 15 with BFgt6 months
• SIDS less 36 with any BF vs. none

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History of Physicians Knowledge and Attitudes
Freed GL
Hollen BK
Schanler RJ
Graph data from the Mothers Survey, Ross
Products Division of Abbott
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Knowledge and Attitudes

• Sometimes it is what we dont say or are too
  vague in saying
• Sometimes its not what we say but what we do
• give out formula company literature and portray
  bottle feeding as the norm in the office setting

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Why Physicians matter?

• Research has shown that that encouragement from
  health care providers is associated with
  breastfeeding initiation
• Lu MC, Lange L, Slusser W, Hamilton J, Halfon N.
  Provider encouragement of breast-feeding
  evidence from a national survey. Obstet
  Gynecol.2001 97 290 295
• and continuation
• Taveras EM, Capra AM, Braveman PA, Jensvold NG,
  Escobar GJ, Lieu TA. Clinician support and
  psychosocial risk factors associated with
  breastfeeding discontinuation. Pediatrics.2003
  112 108 115

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Pediatric clinician factor AOR CI p
Predictors of Not Exclusively Breastfeeding at
12 Weeks, From Multivariate Models Among Mothers
Who Were BF at 4 Weeks   Recommend formula
supplementation if infant is not gaining
enough weight 3.2 (1.049.7) .04  Reported
advice to mothers on breastfeeding duration is
not very important 2.2 (1.23.9)
.01  Does not recommend exclusive breastfeeding
during the first month of life 2.1
(0.954.7) .07
Taveras E. et al. Opinions and Practices of
Clinicians Associated With Continuation of
Exclusive Breastfeeding. PEDIATRICS Vol. 113 No.
4 April 2004, pp. e283-e290
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Why Pediatricians Matter?

• Specific practices and opinions of pediatricians
  were associated with the likelihood of
  continuation of exclusive breastfeeding
• Clinicians who recommended formula
  supplementation or who do not think their advice
  is very important may be sending signals that
  exclusive breastfeeding is not something that
  mothers should value highly
• In addition, many clinicians do not feel
  confident in their skills to support
  breastfeeding and may have limited time to
  address the issue during preventive visits.

Taveras E. et al. Opinions and Practices of
Clinicians Associated With Continuation of
Exclusive Breastfeeding. PEDIATRICS Vol. 113 No.
4 April 2004, pp. e283-e290
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Why Physicians Matter?
Labarere J. et al. Pediatrics. Feb
2005115(2)e139-e146
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Promising Strategies

• AAP BPPOP III Residency Curriculum
• Includes three major sections
• Advocacy
• Clinical Management
• Delivering Culturally Competent Breastfeeding
  Care
• 7 test sites 7 comparison sites

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Outcome Measures

• Knowledge mean difference in scores on posttest
  minus pretest
• Confidence Two measures of confidence-promotion
  of breastfeeding and management of problems
  Scale 1 5 (1 Not At All Confident, 5 Very
  Confident)
• Practice Patterns mean difference scale 1 4 (1
  Never, 2 Once or Twice, 3 Three or Four
  times, and 4 Greater than 5 times) for 10 items
  of practice How many times did you ________ in
  the past 6 months?

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Change in KnowledgeTest vs. Comparison
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Change in Confidence Test vs. Comparison
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Change in Practice Patterns Test vs. Comparison
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Breastfeeding Rates
Significant difference (plt.001) in breastfeeding
rates pre- to post- for the comparison sites vs.
test sites. Although both improved, the test
sites improved significantly more. The main
difference was seen in Caucasians and Hispanics,
and African Americans approached significance,
but other groups numbers were too small in
numbers to determine.
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Additional BPPOP III Activities

• Development of Poster for Physicians Offices
• Teleconferences
• First Teleconference
• Breastfeeding Basics Generalist to Generalist
  presented by Sharon Mass, MD (OB), Jenny Thomas,
  MD (Ped), and Margreete Johnston, MD (Ped) 58
  participants.
• Second Teleconference
• Breastfeeding Promotion Tailored to the Needs of
  a Diverse Society presented by Lori
  Feldman-Winter, MD (Ped), MaryAnn OHara, MD
  (FP), and Michal Young (Ped) 35 participants.

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Poster Breastfeeding is the First Immunization

• Created in collaboration with the AAP Section on
  Breastfeeding and the Childhood Immunization
  Support Program, a program funded by the CDC.
• Available during World Breastfeeding Week to
  physicians, hospitals, WIC sites, and public
  health agencies.

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What Physicians Can/Should Do

• Learn Attend a workshops on breastfeeding
  management AAP, NCE, ABM, LLL Physicians
  Seminar Use the physicians handbook
  (AAP/ACOG/AAFP)
• See one do one teach one
• Eliminateformula companys influence
• Decorateuse breastfeeding posters with images of
  multiple cultures

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Learn
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See one do one teach one
Photo courtesy of Jane Morton, MD
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Eliminate
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Decorate