title: Breastfeeding initiation in the context of a home intervention to promote better birth outcomes.
abstract: OBJECTIVE
  This secondary analysis examined breastfeeding initiation rates and factors related to initiation in a sample of multiparous women with a history of a prior preterm birth.
  
  
  METHODS
  Data for a subsample of women (n=130) were derived from a randomized clinical trial testing a home visit intervention to improve birth outcomes. The subsample included women who gave birth to an infant greater than 35 weeks of gestation. All participants received standard prenatal care. Intervention participants (n=73) also received home visits by certified nurse-midwives. Visits were guided by protocols to improve factors associated with poor birth outcomes and maternal and infant health. Descriptive and logistic regression analyses were used, controlling for factors previously associated with breastfeeding.
  
  
  RESULTS
  Although 85% of women reported an intention to breastfeed, only 65% reported initiating breastfeeding at 48 hours postpartum. After controlling for race, income, marital status, smoking, and age, higher maternal education and lower pregravid body mass index were associated with higher rates of initiation (odds ratio [OR]=1.30, p=0.010 and OR=0.94, p=0.007, respectively). Lower levels of depressive symptoms (OR=0.95, p=0.039) and higher levels of prenatal stress (OR=1.11, p=0.042) increased the likelihood of initiating breastfeeding. No difference between groups emerged, although women in the intervention group with more home visit time were more likely to report breastfeeding (p=0.007).
  
  
  CONCLUSIONS
  Modifiable risk factors were associated with rates of breastfeeding initiation. It may be possible to use protocols delivered via nurse-midwife home visits within a global intervention to increase breastfeeding initiation.
authors.affiliation: Schools of Nursing and Medicine (Division of General Pediatrics), Vanderbilt University, Nashville, TN 37240, USA. sharon.karp@vanderbilt.edu
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Karp
authors.forename: Abigail
authors.initials: A
authors.lastname: Howe-Heyman
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Melanie
authors.initials: M
authors.lastname: Lutenbacher
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data*; D003863:Depression / Q000150:complications; D005260:Female; D006293:Health Promotion; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009721:Nurse Midwives; D011247:Pregnancy; D011584:Psychology; D012044:Regression Analysis; D055815:Young Adult