title: Characteristics of breastfeeding discussions at the initial prenatal visit.
abstract: OBJECTIVE
  To describe the observed characteristics of first prenatal visit breastfeeding discussions between obstetric providers and their pregnant patients.
  
  
  METHODS
  This analysis was part of a larger study involving 69 health care providers and 377 patients attending their initial prenatal visits at a single clinic. Audio recordings and transcripts from the first 172 visits (including 36 obstetric-gynecology residents, six nurse midwives, and five nurse practitioners) were reviewed for breastfeeding discussion occurrence, timing and initiator of discussions, and adherence to American College of Obstetricians and Gynecologists (College) prenatal breastfeeding guidelines. Descriptive statistics were used to characterize the sample and frequency of breastfeeding discussions. Logistic regression and χ tests were used to examine patterns in women's breastfeeding discussion preferences and discussion occurrence. Conversations were qualitatively analyzed for breastfeeding content.
  
  
  RESULTS
  Breastfeeding discussions were infrequent (29% of visits), brief (mean 39 seconds), and most often initiated by clinicians in an ambivalent manner. Sixty-nine percent of breastfeeding discussions incorporated any College breastfeeding recommendations. Breastfeeding was significantly more likely to be discussed by certified nurse midwives than residents (odds ratio 24.54, 95% confidence interval 3.78-159.06; P<.01), and certified nurse midwives tended to engage patients in more open discussions. Women indicating a preference for breastfeeding discussions at the first visit (n=19) were more likely to actually have the discussion (P<.001).
  
  
  CONCLUSIONS
  Observed breastfeeding education at the first prenatal visit was suboptimal. The causes and effect of this deficiency on breastfeeding outcomes remains an important point of investigation.
  
  
  METHODS
  : II.
authors.affiliation: Departments of Pediatrics and Obstetrics, Gynecology & Reproductive Sciences and the Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Jill R
authors.initials: JR
authors.lastname: Demirci
authors.forename: Debra L
authors.initials: DL
authors.lastname: Bogen
authors.forename: Cynthia
authors.initials: C
authors.lastname: Holland
authors.forename: Jill A
authors.initials: JA
authors.lastname: Tarr
authors.forename: Doris
authors.initials: D
authors.lastname: Rubio
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Marianne
authors.initials: M
authors.lastname: Nemecek
authors.forename: Judy C
authors.initials: JC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D003142:Communication; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009721:Nurse Midwives; D009722:Nurse Practitioners; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010820:Physicians; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D013637:Tape Recording; D055815:Young Adult