Breast-feeding counseling practices of family practice residents.
BACKGROUND
Despite breast-feeding being the best newborn feeding method, the percentage of women in the United States who breast-feed has declined. Family physicians are in a unique position to counsel women about breast-feeding because their emphasis on continuity of care provides both prenatal and postnatal contact. Whether family physicians are trained sufficiently to offer such counseling is unknown.


METHODS
A pretested questionnaire was distributed to all residents in 11 of 14 residency programs in North Carolina and Georgia. Data were analyzed with descriptive chi-square statistics and backward logistic regression to assess variables independently predictive of residents' counseling behaviors.


RESULTS
One hundred fifty-five residents filled out usable surveys (response rate: 69%). The residents' primary teachers of breast-feeding were family physicians (34%) and nurses (33%). Most residents (93%) felt it was their personal responsibility to counsel women about breast-feeding; 67% believed their training was inadequate, and 48% stated they lacked necessary skills. Forty-one percent of residents counseled such women less than 50% of the time. Personal or spousal breast-feeding experiences gave residents more confidence in breast-feeding anticipatory guidance (P < .001), comfort in teaching techniques (P < .001), and effectiveness in counseling (P < .009) but did not lead to improved counseling rates. Multivariate analysis showed that female residents, those with high confidence in their breast-feeding counseling skills, and residents that had adequate training in breast-feeding counseling instructed women more often about breast-feeding.


CONCLUSIONS
Breast-feeding counseling skills are an important but neglected aspect of family practice clinical training. Personal breast-feeding experience is an important indicator of breast-feeding counseling confidence and effectiveness, although it doesn't ensure that proper counseling skills are obtained. Family medicine training programs should incorporate breast-feeding educational programs into their residency curricula.
Goldstein
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Department of Family Medicine, Robert Wood Johnson Clinical Scholars Program, University of North Carolina at Chapel Hill.
Freed
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D001942:Breast Feeding; D003376:Counseling; D003479:Curriculum; D005194:Family Practice / Q000193:education; D005260:Female; D005845:Georgia; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009657:North Carolina; D010353:Patient Education as Topic; D010821:Physicians, Family / Q000523:psychology*