NUTN 507: Seminar

Graduate Programs in Human Nutrition

February 9, 2015
12:15 PM
Presented By Amanda Rosenberg

Interventions to Promote the Exclusivity & Extend the Duration of Breastfeeding

After attending this presentation, members of the audience will be able to:
1. Describe the components of the baby-friendly hospital initiative.
2. Evaluate the use of motivational interviewing and peer counseling for breastfeeding support.
3. Identify special groups that require specific interventions for breastfeeding support.
Successful, long-term breastfeeding begins with a successful start. The Baby-Friendly Hospital
Initiative (BFHI) was conceived in 1991 by the World Health Organization (WHO) and the United Nations
Childrens Fund (UNICEF) to provide this successful start and improve worldwide breastfeeding rates (1,
2). Hospitals and birth centers can be designated as Baby-Friendly if they show compliance with the
Ten Steps to Successful Breastfeeding by demonstrating accordance with hospital/birth center policy,
staff training, and post-partum practices (1). The BFHI has been shown to increase breastfeeding
initiation, continuation, and exclusivity, sustainably over time (1, 3, 4).
Motivational interviewing (MI) is a type of counseling that focuses on decreasing patient/client
ambivalence and has been used by various health professionals to promote behavior change in a variety
of health conditions (5). The four principles that are used in MI are: express empathy, create
discrepancy, roll with resistance to hear the reasons for ambivalence, and support self-efficacy (5).
Clinicians that have been trained in MI have been shown to assist mothers in maintaining exclusive
breastfeeding to 4 months postpartum (6) and have a higher rate of breastfeeding at 6 months
postpartum (5). Peer counseling is a specific type of social support that incorporates information,
appraisal, and emotional assistance by peers who are not part of a persons family or immediate social
network (7). Peer counselors are unique because they possess experiential knowledge of the targeted
behavior and also have similar demographics to those they are assisting (7). Peer counseling is routinely
utilized by community programs, such as Women, Infants, and Children (WIC). The effect of peer
counseling on breastfeeding duration and exclusivity has produced mixed results. One study concluded
that breastfeeding mothers who received peer counseling had demonstrated a higher breastfeeding
duration and a higher rate of breastfeeding exclusivity in the first 3 months postpartum (7). A more
recent randomized controlled trial found no statistical difference in breastfeeding duration for mothers
who received peer counseling compared to those who received routine breastfeeding support (8).
Certain groups of breastfeeding mothers require specialized breastfeeding intervention and
support. Women who require a caesarean section for delivery have additional factors that may influence
breastfeeding initiation and duration, including delayed breastfeeding initiation, surgery fatigue and pain,
and breastfeeding positioning difficulty (9, 10). Women who return to the workplace can potentially face
barriers to continued breastfeeding, including appropriate pumping facilities and the ability to have
flexible hours (11-13). Workplace policy and culture can directly influence the exclusivity and duration of
breastfeeding of a working mother (11, 13). Lastly, adolescent mothers have unique barriers to
breastfeeding, including skewed maternal perception, societal barriers, and a lack of prenatal care (14,
15). These groups require different breastfeeding interventions to increase duration and exclusivity of
breastfeeding.
There are numerous interventions to increase the duration and exclusivity of breastfeeding.
Interventions can be implemented prenatally, during labor and delivery, and during the postpartum
period. Some groups of women may benefit from additional intervention to ensure their success of
breastfeeding. In conclusion, multiple interventions at different points of time and different techniques
may be necessary to have the best impact on breastfeeding duration and exclusivity.

References
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2. Kramer M, Chalmers B, Hodnett E, Sevkovskaya Z, Dzikovich I, Shaprio S, Collet J, Vanilovich I, Mezen I, Ducruet
T, et al. Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA
2001;285(4):413-420.
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