title: Mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits.
abstract: BACKGROUND
  Recent national statistics indicate that, despite increases in the proportion of mothers who initiate breastfeeding, the proportion that continue to breastfeed their infants through 6 months of age remains below the Healthy People 2010 goal of 50%. National professional organizations recommend that clinicians routinely counsel mothers about the benefits of breastfeeding. Little is known, however, about the counseling provided during these visits and how mothers and their clinicians perceive breastfeeding counseling.
  
  
  OBJECTIVE
  We sought to describe mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits and identify potential gaps in communication about breastfeeding and management practices.
  
  
  METHODS
  We conducted a prospective cohort study of low-risk mother-newborn pairs and their clinicians in a large multispecialty group practice. The participating mothers completed telephone interviews at 4 and 12 weeks postpartum, and their data were linked with their obstetric and pediatric clinicians' responses to a cross-sectional mailed survey conducted during the same time period. Overall, response rates were 63% for mothers (n = 429) and 82% for clinicians (obstetric clinicians: n = 54; pediatric clinicians: n = 67).
  
  
  RESULTS
  Of the 429 low-risk mother-newborn pairs in the study, 61% were white, 16% were black, 10% were Hispanic, and 8% were Asian, with a mean (SD) age of 32.7 (5.1) years. At 4 weeks postpartum, 319 mothers (74%) were either exclusively or mixed breastfeeding. According to the interviews, few mothers discussed breastfeeding duration with their obstetric clinicians during their prenatal visits (15%) or with their pediatric clinicians during their infants' 2-week preventive visit (24%). Among 164 mothers whose obstetric providers said they usually or always discuss breastfeeding duration during prenatal visits, only 26 (16%) of the mothers reported that the topic was discussed with them (22% agreement; kappa = -.004). Among those mothers whose pediatric clinicians said they usually or always discuss breastfeeding duration during the 2-week preventive visit, only 25% of the mothers reported that the topic was discussed (32% agreement; kappa =.05). Many of the mothers had either returned to work by 12 weeks (29%) or planned to return to work within the next few months (43%). Although nearly all the obstetric (91%) and pediatric (97%) clinicians reported that they usually or always discuss whether a mother plans to continue breastfeeding after returning to work, only approximately half (55%) of the mothers seen by the clinicians reported that the topic was discussed. Overall, few mothers reported discussing with their clinicians specific ways to continue breastfeeding after returning to work.
  
  
  CONCLUSIONS
  Mothers' reports of breastfeeding advice given during routine preventive visits identified several areas in which unintentional communication gaps may occur, including specifics about breastfeeding duration and methods of breastfeeding after returning to work. Developing approaches to enhance communication with mothers during routine preventive visits could improve the support of breastfeeding.
authors.affiliation: Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts 02215, USA. elsie.taveras@childrens.harvard.edu
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Ruowei
authors.initials: R
authors.lastname: Li
authors.forename: Laurence
authors.initials: L
authors.lastname: Grummer-Strawn
authors.forename: Marcie
authors.initials: M
authors.lastname: Richardson
authors.forename: Richard
authors.initials: R
authors.lastname: Marshall
authors.forename: Virginia H
authors.initials: VH
authors.lastname: Rêgo
authors.forename: Irina
authors.initials: I
authors.lastname: Miroshnik
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001942:Breast Feeding / Q000523:psychology*; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers / Q000523:psychology*; D009774:Obstetrics; D010372:Pediatrics; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011446:Prospective Studies; D014481:United States