Infant Feeding Practices and Perceived Optimal Breastfeeding Interventions among Low-Income Women Delivering at a Baby-Friendly Hospital

Abstract

Objective To determine infant feeding practices of low-income women at a Baby-Friendly Hospital and to ascertain breastfeeding interventions they believe would increase exclusive breastfeeding. Study Design This cross-sectional study occurred at a tertiary care Baby-Friendly Hospital. Low-income women without breastfeeding contraindications were recruited at scheduled obstetrician/gynecologist appointments within 6 to 9 months of delivering a term, nonanomalous infant. Participants completed a survey. Outcomes included infant feeding patterns and perceived usefulness of proposed breastfeeding interventions. Results Of 149 participants, 129 (86.6%) initiated breastfeeding; by postpartum day 2 (PPD2), 47 (31.5%) exclusively breastfed, 51 (34.2%) breastfed with formula, and 51 (34.2%) exclusively formula fed. On a scale of 1 (“strongly agree”) to 5 (“strongly disagree”), women who supplemented with formula on PPD2 were significantly more likely than those who exclusively formula fed to agree education on neonatal behavior, 1 (interquartile range [IQR] 1, 2) versus 2 (IQR 1, 3); p = 0.026 and on-demand access to breastfeeding videos on latch or positioning, 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.043; 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.021, respectively, would have helped them exclusively breastfeed. Conclusion Though low-income women at a Baby-Friendly Hospital had high breastfeeding initiation rates, the majority used formula by PPD2. To increase breastfeeding rates among low-income women, future interventions should provide appropriate and effective breastfeeding interventions.

Impact of a novel smartphone application on low-income, first-time mothers’ breastfeeding rates: a randomized controlled trial

“…As reported previously, 6 while in the hospital, women who nonexclusively breastfed at postpartum day 2 were less likely to ask for in-person breastfeeding help-and more likely to report inperson help did not solve their breastfeeding issue-when compared with women who exclusively breastfed or exclusively formula fed at postpartum day 2. 6 In addition, women were asked to select from a list of in-person or virtual breastfeeding support options that they believed would have helped them prolong their duration of exclusive breastfeeding. All women reported having on-demand access to videos on breastfeeding and normal infant behavior would have helped them exclusively breastfeed.…”

“…3,17 Various explanations have been proposed for this racial inequity, such as a lack of support from professionals and family members, lack of knowledge of breastfeeding benefits, and lack of education on how to overcome common breastfeeding issues. 3,6,17,18 The BFF app was developed using findings from our previous study that identified specific barriers that low-income women believed prevented them from exclusively breastfeeding 6 and was further optimized by multiple focus groups of target end users (low-income, predominantly black women). However, the complex postpartum environmental factors of our study population may have limited the BFF app's effectiveness to increase breastfeeding equity in this high-needs population.…”

“…A multidisciplinary team of lactation consultants, perinatologists, and neonatologists used results from our previous cross-sectional survey 6 to create the prototype for our de novo breastfeeding smartphone app, Breastfeeding Friend (BFF). A middle school teacher ensured all educational content was at fifth-grade reading level.…”

“…This Contents of Breastfeeding Friend (BFF) app OBSTETRICS Original Research endpoint was chosen because our previous cross-sectional study found that most low-income women who initiated breastfeeding introduced formula by postpartum day 2. 6 Secondary infant nutrition outcomes included breastfeeding initiation and exclusive and nonexclusive breastfeeding at 6 weeks, 3 months, and 6 months postpartum. Other secondary outcomes included patient-reported breastfeeding challenges and reasons for formula initiation: participants were asked to choose all pertinent responses from a list and write responses that were not present.…”

“…All women reported having on-demand access to videos on breastfeeding and normal infant behavior would have helped them exclusively breastfeed. 6 These results encouraged us to consider trialing a technology-based intervention adjunct to Baby-Friendly practices to help low-income women who initiated breastfeeding prolong their duration of exclusive breastfeeding.…”