Departments of Pediatrics and Obstetrics, Gynecology & Reproductive Sciences and the Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2013 Dec;122(6):1263-70. doi: 10.1097/01.AOG.0000435453.93732.a6.
To describe the observed characteristics of first prenatal visit breastfeeding discussions between obstetric providers and their pregnant patients.
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.
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).
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.
: II.
描述产科医生与其孕妇患者首次产前检查时母乳喂养讨论的观察特征。
本分析是一项更大研究的一部分，该研究涉及在一家诊所参加首次产前检查的 69 名医疗保健提供者和 377 名患者。对前 172 次就诊（包括 36 名妇产科住院医师、6 名助产士和 5 名执业护士）的音频记录和记录进行了回顾，以了解母乳喂养讨论的发生情况、讨论的时间和发起者，以及是否遵守美国妇产科医师学院（学院）产前母乳喂养指南。使用描述性统计来描述样本和母乳喂养讨论的频率。使用逻辑回归和 χ 检验来检查女性对母乳喂养讨论偏好和讨论发生的模式。对对话进行定性分析，以确定母乳喂养内容。
母乳喂养讨论很少（29%的就诊），时间很短（平均 39 秒），并且大多数是由临床医生以矛盾的方式发起的。69%的母乳喂养讨论纳入了任何学院的母乳喂养建议。注册助产士比住院医师更有可能进行母乳喂养讨论（优势比 24.54，95%置信区间 3.78-159.06；P<.01），并且注册助产士倾向于与患者进行更开放的讨论。在首次就诊时表示希望进行母乳喂养讨论的女性（n=19）更有可能进行实际讨论（P<.001）。
首次产前检查时母乳喂养教育的效果并不理想。这种不足对母乳喂养结果的影响及其原因仍然是一个重要的研究点。
II。
