Breast is Best: Increasing Healthcare Provider Knowledge and Confidence

Abstract

Background:  The purpose of this project was to increase breastfeeding knowledge and confidence in healthcare providers (HCPs) involved in the care of pregnant women in rural Obstetrical clinics.  Obstetrical healthcare providers are responsible for the care and well-being of pregnant women and their fetuses.  One of the most highly effective preventive measures a mother can take to protect the health of her infant is to breastfeed.  The breastfeeding success rate among mothers can be greatly improved through active support from their families, friends, communities, and healthcare providers. 

Methods:  The project sites were three separate rural obstetrical clinics in middle Tennessee.  Informed Consent was obtained from providers participating in the project.  A Pre-Knowledge and Confidence Questionnaire on Breastfeeding was administered to the healthcare providers.  An educational program from the American Academy of Pediatrics (AAP), “Breastfeeding Residency Curriculum” consisting of PowerPoints, case studies, and the use of reference tools was presented to all participants.  Three presentations were conducted at each site.  Healthcare providers counsel pregnant women about breastfeeding using the American Congress of Obstetricians and Gynecologists (ACOG) Perinatal Practice Guidelines. .  The healthcare providers documented their counseling efforts in the patient’s Electronic Medical Record (EMR).   Patient charts were reviewed for comparison of pre-implementation to post-implementation breastfeeding counseling documentation by providers.  The three month pre-implementation review included patient visits from January 2014 through March 2014.   In developing a project baseline, this pre-implementation chart review established the number of times patients received breastfeeding counseling and prenatal visits from the healthcare providers.  Once the educational program was implemented, another chart review was conducted, in the same manner as the pre-implementation review.   The post-implementation review incorporated the period of April 2015 through June 2015.  A comparison was made between the two reviews to determine any effect of the educational intervention on the providers counseling and documentation.  At the end of the three month project, a Post- Knowledge and Confidence Questionnaire on Breastfeeding was presented to the healthcare providers.

Results: It is projected that healthcare providers who complete the American Academy of Pediatrics (AAP) “Breastfeeding Residency Curriculum” will display enhanced breastfeeding knowledge and confidence, and will exhibit positive changes to breastfeeding practice patterns. Short-term project goals include a 25% increase in utilization of ACOG breastfeeding recommendations (based on retrospective chart review), and a 25% increase in HCP breastfeeding knowledge through pre/post-testing, and a 25% increase in HCP confidence in breastfeeding counseling abilities through pre/post-testing.  Long-term goals after completion of the educational program include a 50% increase in utilization of breastfeeding recommendations from ACOG, an increase in the number of patients with intent to breastfeed, and an increase in the number of patients who attempt to breastfeed prior to discharge from the hospital after delivery.

Conclusions: The breastfeeding success rate among mothers can be greatly improved through active support from their healthcare providers.  More breastfeeding education is required for healthcare providers to become both knowledgeable and confident in their skills to promote breastfeeding and manage the breastfeeding client.