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J Hum Lact. 2019 Mar 6:890334419830996. doi: 10.1177/0890334419830996. [Epub ahead of print]

Prenatal Provider Support for Breastfeeding: Changes in Attitudes, Practices and Recommendations Over 22 Years.

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1 Assistant Professor of Pediatrics and Obstetrics and Gynecology, Medical Director of Lactation Services and Programs, University of Rochester School of Medicine and Dentistry.
2 Pediatric Resident, University of Minnesota at Minneapolis, MN, USA.
3 Fulbright Award Recipient, Jamaica.
4 MD, University of Rochester School of Medicine and Dentistry.
5 MD, University of Rochester School of Medicine and Dentistry.
6 MD, Professor of Pediatrics and Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Medical Director of the Ruth A. Lawrence Poison and Drug Information Center and of the Breastfeeding and Human Lactation Study Center.



Prenatal care providers play a central role in breastfeeding outcomes. A survey on obstetricians' support of breastfeeding was conducted in 1993 in Monroe County, NY. Since the landscape of prenatal care and breastfeeding support has changed significantly in the past 2 decades, we repeated and extended this survey in 2015.


To determine changes in breastfeeding support by prenatal care providers over a 20 year period.


We sent a 46-item on-line or paper questionnaire to all categories of prenatal care providers identified by an online search. A breastfeeding support score was created based on the prior survey, with a maximum score of 3. One point was awarded for: 1) personally discussing breastfeeding; 2) generally suggesting breastfeeding; and 3) commonly receiving questions from patients. Data were analyzed using Chi-square.


We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p<0.001) and recommending (93% vs. 80%, p=0.001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p<0.0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p<0.001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p<0.0001).


Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.


Breastfeeding; breastfeeding knowledge; breastfeeding support; infant formula


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