Does Prenatal Breastfeeding Education Impact Exclusive Breastfeeding in the Hospital? An Examination of Prenatal Classes, Self-Efficacy, Previous Experience, Hospital Practices, Race, and Intention as Contributing Factors

Objectives: The purpose of this paper is to examine whether prenatal breastfeeding education, possibly mediated by breastfeeding self-efficacy, is associated with exclusive breastfeeding during the hospital stay. It will also address whether or not the impact of this association varies by race. Previous breastfeeding experience, exclusive breastfeeding supportive hospital practices, and breastfeeding intention are observed as possible confounding factors. Background: As rates of breastfeeding initiation are rising, the focus is increasing on methods to support improved duration. Research shows that prenatal breastfeeding promotion and education are helpful in terms of building confidence in new mothers and preparing them for what to expect once their infant arrives. This paper is based on an on-going evaluation of the Ready, Set, Baby (RSB) prenatal breastfeeding education program offered at the University of North Carolina Chapel Hill (UNC) Women's Hospital. Researchers are especially interested in program effectiveness and potential barriers to program participation as expansion of RSB is a future goal. Data collected during the 2013 summer phase was used to create this paper. Methods: The student researcher collaborated with the Carolina Global Breastfeeding Institute at UNC and the UNC Women's Hospital to conduct postpartum interviews with mothers who received prenatal care at UNC hospital and who, therefore, were in the population that could have been offered the RSB educational sessions. Results: Of the 76 women in the study, 28% identified as African American/Non-Hispanic, 43% as Caucasian/Non-Hispanic, 1% as Asian/Non-Hispanic, 3% as Other/Non-Hispanic and 25% as Hispanic. About 61% of the population, the majority of whom were Caucasian, exclusively breastfed their infants during the entire hospital stay. Caucasian women also had the highest breastfeeding self-efficacy scores. The mean score among all women in the study was 60 out of 70; the score was slightly higher at 62.7 in women who exclusively breastfed. About 25% of women took a prenatal breastfeeding class to prepare for the arrival of their infant; 26% of whom exclusively breastfed. About 56% of all women reported having previously breastfed. Among this group 60% exclusively breastfed their infants. The mean breastfeeding intention score was 7.9 out of 16. Yet the mean score for intention was lower (5.6) among exclusive breastfeeding women. African American and Hispanic women took prenatal breastfeeding classes more often than Caucasian women, had more previous breastfeeding experience and higher intentions to breastfeed. All women in the study rated their exclusive breastfeeding supportive hospital care as "8 out of 10" or better. The mean score was 9.5 with Caucasian and Hispanic women reporting slightly higher ratings than African Americans. Discussion and Conclusions: In contrast with most current research, this study did not strongly support the idea that factors of prenatal breastfeeding education, self-efficacy, previous breastfeeding experience, exclusive breastfeeding supportive hospital practices and breastfeeding intention predict exclusive breastfeeding in the hospital. This study did not explain the racial/ethnic disparities that exist and may need to be expanded to include a larger sample size to obtain significant findings. Other factors are important to consider especially among minority populations and support and breastfeeding education alone may not be enough for all women to achieve exclusive breastfeeding. The benefits of breastfeeding (and the costs of not breastfeeding) can be seen throughout the lifespan; by addressing racial/ethnic disparities among infants, researchers may also address racial/ethnic health disparities that exist in adults.Master of Public Healt