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Characteristics of Breastfeeding Discussions at the Initial Prenatal Visit

Demirci, Jill R. PhD; Bogen, Debra L. MD; Holland, Cynthia MPH; Tarr, Jill A. MSW; Rubio, Doris PhD; Li, Jie MS; Nemecek, Marianne MPH; Chang, Judy C. MD

doi: 10.1097/01.AOG.0000435453.93732.a6
Contents: Original Research

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 χ2 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).

CONCLUSION: 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.


At the first prenatal visit, patient–provider breastfeeding discussions are infrequent and tend toward brief, superficial assessments of feeding plans and rote lists of breastfeeding benefits.

Departments of Pediatrics and Obstetrics, Gynecology & Reproductive Sciences and the Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Corresponding author: Jill R. Demirci, PhD, 3414 Fifth Avenue, 3rd Floor, Pittsburgh, PA 15213; e-mail:

Funded by the National Institute on Drug Abuse (R01 DA026410, Principal Investigator Chang). Dr. Demirci's work on the project was supported through a Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (T32HP22240 HRSA NRSA for Primary Medical Care).

Presented orally at the International Conference on Communication in Healthcare, Montréal, Quebec, Canada, September 30, 2013.

The study/recruitment site was Magee-Womens Hospital of the University of Pittsburgh Medical Center outpatient clinic, Pittsburgh, Pennsylvania.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.