The survey was sent electronically to physicians and midwives within the obstetric, pediatric and neonatology specialties and registered nurses employed within the same areas. A total of forty-nine surveys were completed by obstetricians, midwives, neonatologists, pediatricians and registered nurses resulting in a response rate of 56.6%.
Data were analyzed using descriptive and inferential statistics using SPSS version 19. The total score for the IIFAS and Breastfeeding Attitudes Scale were calculated separately by adding the scores for each item. The sample was divided into four categories: obstetricians and midwives, neonatologists, pediatricians and registered nurses. The rationale for separating the groups was to see if there were obvious differences between the attitudes, perceptions and knowledge scores for each discipline. Independent sample t-tests, Pearson’s correlation coefficient, and Pearson’s chi square (x2) were used to assess differences between the groups. Differences were considered significant if the p value was less than 0.05 (Pallant, 2013).
Perceptions of breastfeeding differed between physicians and nurses and among specialties. There were significant differences between how pediatricians, neonatologists and obstetricians perceived breast milk as the ideal food for babies, with obstetricians and neonatologists reporting “strongly agree” (n=22) with pediatricians “agree” only or “neutral” (n=7) (p=0.017). Overall, physicians, midwives, and nurses across all specialties achieved high scores that indicated positive attitudes toward breastfeeding. However, more obstetricians, neonatologists and midwives “strongly agree” that it is important for a baby to receive breast milk (n=22, 44.8%) compared to 5 pediatricians (38.7%). Knowledge about breastfeeding, however, demonstrated that pediatricians differed was consistent among all the caregivers across the specialties. However, significant differences existed related to knowledge about breastfeeding. More pediatricians strongly agreed that breast size impacts a woman's ability to breastfeed (p=0.008), that nipple shields prevent cracked nipples (p=0.003) and disagreed that bottle feeding complicates breastfeeding (p=0.005).
In the community hospital setting, the pediatrician is likely responsible for ordering a feeding regimen for a baby. Our data demonstrates that the pediatricians in our organization have a less favorable attitudes and perceptions about breastfeeding overall. Further, the pediatricians also demonstrated a general difference in their general knowledge of breastfeeding compared to their obstetric and neonatal colleagues. Pediatricians may be less supportive, then, of breastfeeding as the sole source of infant nutrition and not encourage, or support, new mothers from exclusively breastfeeding their infants. The lack of support, promotion, or encouragement for new mothers could, potentially, contribute to an organization's low performance toward sustaining exclusive breastfeeding rates. With this new knowledge, the need for more research, both quantitative and qualitative, is evident to further explore the impact of the pediatrician on a woman's choice to exclusively breastfeed her infant and, conversely, an organization's ability to sustain exclusive breastfeeding during the immediate postpartum period.