1 / 30

Disclaimer

Exclusive breast-feeding rates upon discharge from hospital in St. John ’ s (2007-2008): a chart review MONICA KIDD, MD, MSc Memorial University of Newfoundland Discipline of Family Medicine & STEPHANIE BENNETT, B.A. University of British Columbia. Disclaimer. The Ideal.

kaiya
Download Presentation

Disclaimer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Exclusive breast-feeding rates upon discharge from hospital in St. John’s (2007-2008): a chart reviewMONICA KIDD, MD, MScMemorial University of Newfoundland Discipline of Family Medicine&STEPHANIE BENNETT, B.A.University of British Columbia

  2. Disclaimer

  3. The Ideal “We declare that as a global goal for maternal and child health and nutrition, all women should be enabled to practise exclusive breastfeeding and all infants should be fed exclusively on breast milk from birth to 4-6 months of age.”

  4. Reality… initiation

  5. Reality… duration

  6. Global breastfeeding rates Source: WHO Global Data Bank on Infant and Young Child Feeding (http://www.who.int/nutrition/databases/infantfeeding/en/ accessed Sept 3, 2010)

  7. Research questions • To determine breastfeeding rates (any at all, and exclusivity) at discharge from hospital • To determine whether breast-feeding is correlated, as it has been in other studies, with maternal demographics and labour/delivery parameters.

  8. Why people don’t breastfeed • mom less than 25 years • low educational attainment • lower socioeconomic status • smoking during pregnancy • maternal obesity • multiple gestation • cesarean birth and first births • introduction of formula during the hospital stay • early maternal return to work • relationship distress • lack of family support (esp. Nan!)

  9. Who sent me this??

  10. “Many months later, I have a healthy, happy child with whom I spend much of each day, learning new words, throwing new tantrums. She sleeps through the night (and has since five and a half months old, well topped up with “moo,” as we called her formula) and I sleep better too. I am healthier and happier for the experience, and for the fact I did it my way.” Globe & Mail Friday, Sept 3, 2010

  11. Globe & Mail, Sept 23, 2010

  12. Methods • Requested a list of all charts of women who delivered at the Janeway between June 1, 2007 and May 30, 2008 (n=2550) • Cross-referenced moms and babies and assigned random numbers • Pulled 250 (~10%) pairs

  13. Data collection:Newfoundland and Labrador Prenatal Record & Live Birth Notification • baby’s sex • singleton or twin gestation • maternal age at delivery • gravida and para • smoking status during pregnancy • maternal complications other than UTI or N/V • drugs other than prenatal vitamins and Diclectin • level of formal education attained • mode of delivery • whether main prenatal care given by an obstetrician or family doctor • gestational age • birth weight

  14. Data collection: Newborn Discharge Record & Infant Data Flow Sheet • NICU admission • whether the child was labeled as breast- or bottle-fed on the discharge record • the number and sequence of breast, formula, and supplemented feedings (i.e. breast milk followed by formula).

  15. Data we tried to collect(but were inconsistently charted) • social supports • intention to breastfeed • number of prenatal visits

  16. Data analysis • Bivariate correlations to determine which factors are significantly associated with outcome (% breast of all feeds) • Multivariate regression using significant factors to determine overall predictive ability of factors

  17. Results: demographics

  18. Results: feeding • Neonatal Discharge Record: • 166 (66.4%) breastfed • 74 (29.6%) formula-fed • 10 (4.0%) missing • Infant Data Flow Sheet: • 64 (25.6%) exclusively breastfed • 89 (35.6%) supplemented • 17 (6.8%) began breastfeeding, but switched to formula • 80 (32.0%) exclusively formula-fed

  19. Results: bivariate comparisons R=-0.251 (p=0.000) R=0.033 (p=0.599) R=-0.276 (p=0.000***) R=-0.348 (p=0.000***)

  20. Results: bivariate comparisons (cont’d) R=-0.266 (p=0.000***) R=-0.088 (p=0.164) R=-0.030 (p=0.638) R=-0.185 (p=0.003)

  21. Results: bivariate comparisons (cont’d) R=-0.045 (p=0.495) R=-0.150 (p=0.018) R=-0.006 (p=0.921) R=--0.114 (p=0.073)

  22. Results: bivariate comparisons (cont’d) R=-0.190 (p=0.003) R=-0.222 (p=0.000)

  23. Results: Multiple Regression F= 6.976 (p=0.000); R2=0.238

  24. Conclusions • Only 25.6% of infants in St. John’s exclusively breastfed on discharge. • 66.4% listed as breastfed on their Neonatal Discharge Record • Stats Can reports a Newfoundland and Labrador provincial initiation rate of 69.1% based on maternal recall • MUCH LOWER rate than the 41.7% Matthews et al. (1995) found nearly twenty years ago from a province-wide prospective questionnaire based study

  25. Conclusions (cont’d) • High rate (35.6%) of formula supplementation. • Do infants who are supplemented meet the ABM criteria? • Could supplementation rates be associated with time of day, staff work load, staff preference, or staff perceptions of maternal ability to breastfeed?

  26. Conclusions (cont’d) 3. Significant predictors of breastfeeding: • single vs. gestation • maternal age at delivery • formal education • (no) drugs other than prenatal vitamins or anti-emetics • delivery by a family doctor (13.6%) rather than an Ob/Gyn* • higher birth weight • no NICU admission

  27. Acknowledgments • Serge Beaulieu, Linda Byrne and Phyllis Nagle (Eastern Health) • Shabnam Asghari, Kris Aubrey-Bassler and Marshall Godwin for stats advice • Lorraine Burrage, Anne Drover, Janet Murphy-Goodridge and Wanda Parsons for insights

More Related