by Anne Eglash MD, IBCLC, FABM
Are women more likely to be successful breastfeeding if they receive care from one type of birth attendant vs another?
There has been a rise in the % of pregnant women whose pregnancies and births are managed by midwives versus obstetricians or family physicians. Studies of breastfeeding knowledge among providers indicate that midwives have more knowledge of breastfeeding benefits and greater self-confidence in managing breastfeeding problems as compared to obstetricians, pediatricians, and family physicians.
The question is whether this increased knowledge is associated with improved breastfeeding outcomes among women attended by midwives for pregnancy and birth.
The authors of the study for this week’s question evaluated data from the Infant Feeding Practices Survey II. This survey, administered by the Food and Drug Administration and the Center for Disease Control from May 2005- June 2007, asked questions about infant feeding, and what type of birth attendant the mother had. Confounding variables that heavily influence breastfeeding rates such as marital status, race, age, education, etc were controlled for. In addition, they did not include any women in the survey who had birth problems that could have impacted breastfeeding, such as diabetes. They controlled for mode of delivery, since women cared for by OB/Gyns are much more likely to undergo a cesarean birth as compared to women cared for by midwives.
What do you think are true statements regarding breastfeeding outcomes according to birth attendant? Choose 1 or more:
- After adjusting for confounding variables such as marital status, breastfeeding intention, income, etc, mothers with a family physician or other non-OB/gyn physician were 2x as likely to engage in any amount of breastfeeding for at least 6 months compared to those with an obstetrician birth attendant.
- There was no difference in breastfeeding rates if attended by a family physician or a midwife.
- Only women with midwives as birth attendants had higher exclusive breastfeeding rates as compared to obstetricians. Birthing with a family physician did not raise exclusive breastfeeding rates as compared to birthing with an OB/Gyn.
- The increased breastfeeding rate among women attended by midwives is due to the fact that these are women who are more highly educated and have a higher breastfeeding intention.
See the Answer
A and C (not B and D)
Association between Breastfeeding Duration and Type of Birth Attendant
Jordyn T. Wallenborn and Saba W. Masho
Healthcare providers play an integral role in breastfeeding education and subsequent practices; however, the education and support provided to patients may differ by type of provider. The current study aims to evaluate the association between type of birth attendant and breastfeeding duration. Methods. Data from the prospective longitudinal study, Infant Feeding Practices Survey II, was analyzed. Breastfeeding duration and exclusive breastfeeding duration were defined using the American Academy of Pediatrics’ national recommendations. Type of birth attendant was categorized into obstetricians, other physicians, and midwife or nurse midwife. If mothers received prenatal care from a different type of provider than the birth attendant, they were excluded from the analysis. Multinomial logistic regression was conducted to obtain crude and adjusted odds ratios and 95% confidence intervals. Results. Compared to mothers whose births were attended by an obstetrician, mothers with a family doctor or midwife were twice as likely to breastfeed at least six months. Similarly, mothers with a midwife birth attendant were three times as likely to exclusively breastfeed less than six months and six times more likely to exclusively breastfeed at least six months compared to those who had an obstetrician birth attendant. Conclusions. Findings from the current study highlight the importance of birth attendants in breastfeeding decisions. Interventions are needed to overcome barriers physicians encounter while providing breastfeeding support and education. However, this study is limited by several confounding factors that have not been controlled for as well as by the self-selection of the population.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
One problem with this study is that ~80% of the participants in this survey were married, 85.6% were non-Hispanic white, 80% had some amount of college education, so the findings are limited to this demographic.
The authors suggest that midwives have more time during prenatal visits to educate their patients, and because of having more breastfeeding knowledge will provide more breastfeeding education and support. One strength I found in this study is that they controlled for breastfeeding intention. My preconceived notion is that women who seek care with a midwife are more likely to feel confident about their healthcare, and have stronger breastfeeding intentions than women who establish care with an OB/Gyn.
More work needs to be done on this topic, particularly in regard to women of color. We also need studies that drill down into the differences in prenatal support between midwives, family physicians, and OB/Gyns in order to determine best practices by providers that positively influence breastfeeding rates.
sarah willoughby
I think a lactation consultant in every OB-GYN office would be very helpful, for prenatal and postpartum visits.