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Pennsylvania obstetricians' knowledge, attitudes, and recommendations about breastfeeding
TUESDAY, OCTOBER 26 POSTER SESSION: YEAR 2000 HEALTH OBJECTIVES MARYLAND "2000": A JOINT MARYLAND DIETETIC ASSOCIATION AND DEPARTMENT OF HEALTH AND MENTAL HYGIENE EFFORT TO MEET THE YEAR 2000 NUTRITION OBJECTIVES. Y, Bronner, DSC, RD, LD, P. Fatzinger, MS, RD, LD, and Diana Schmidt, MPH, RD, LD, Johns Hopkins University, Johns Hopkins Hospital and Department of Health and Mental Hygiene, Baltimore, MD From 1990 to 1992 Maryland(MD) had the highest cancer mortality (192.8/100,000) of any state; it was second in 1993 statistics(194/100,000). Cardiovascular disease is the leading cause of death in both Maryland men and women. The Maryland Dietetic Associationts(MDA) Legislative Chair wrote to the Governor offering MDA's technical assistance to fight cancer. In response, the Governor directed MDA to meet with the Department of Health and Mental Hygiene's (DHMH) Chronic Disease Division to define specific ways MDA could contribute to the Governor's Cancer Prevention Initiative, DHMH staff developed a document - "Maryland 2000: Meeting the Year 2000 Nutrition Objectives: The Maryland Dietetic Association's Role" that listed 10 tasks that MDA could complete alone or in conjunction with other groups. DHMH awarded a sizeable contract to MDA to conduct these tasks. The tasks included the development of a Maryland 2000 position paper on chronic disease prevention strategies, assessing current resources, coordinating public and private sector groups to implement the prevention strategies and evaluating the impact of interventions. MDA will continue to lobby the General Assembly for funding. The overall goal is to reduce diet behaviors that contribute to cancer and heart disease. In addition, the DHMHDirector of Information and Data Analysis agreed to provide ongoing Maryland-based health statistics for monitoring the program. A core MDA coordinating group convened to develop a response, The group defined financial issues, sub-contracting, dietetic practitioner contributers and a timeline for project completion. This grant will facilitate MDA's role as the natural leader in Maryland Nutrition Prevention efforts. It serves as a demonstration project which can be transported to other states. This project will also begin to position MDA more clearly as the leader in Maryland's Nutrition Community.
PENNSYLVANIA OBSTETRICIANS' KNOWLEDGE, ATTITUDES, AND RECONMENDATIONS ABOUT BREASTFEEDING. J.A. Lohr, MS, RD, and S.S. Dahlheimer, PhD, RD, Department of Food & Nutrition, Indiana University of Pennsylvania, Indiana, PA. The benefits of breastfeeding are widely recognized by most health care professionals. However, the percent of women in the United States who breastfeed their infants and the duration of time they breastfeed have decreased in recent years, in spite of established goals for breastfeeding of 75% at hospital discharge, and at least 35% continuing at five to six months post-partum. One major barrier to increased breastfeeding rates identified by the Surgeon General's report was the lack of knowledge and support by health care professionals. Obstetricians have been noted to be a primary source of information and support for women in the decision of infant feeding method, having direct and ongoing contact during the prenatal period. The purpose of this study was to investigate Pennsylvania obstetricians' knowledge, attitudes and recommendations concerning breastfeeding. thirty item survey instrument was mailed to 436 obstetricians who were registered with the Pennsylvania Medical Society. For the purpose of statistical analyses, 147 (34%) of the 171 returned surveys were usable, 96% of which were completed by the physician. The responses given were compared with current research supported by the literature. Mean scores for knowledge, attitudes, and recommendations were 74%, 81%, and 79%, respectively. Data were also analyzed to identify any significant differences in knowledge, attitudes, or recommendations with respect to age, gender, location of practice, and year of graduation from medical college. A statistically significant difference (=.002) was found between knowledge scores with respect to the obstetrician's age. Specifically, those between the ages of 30 to 39 years and 40 to 49 years scored significantly better than those 50 to 59 years of age. However, no significant differences were found with respect to gender, location of practice, or year of graduation. Finally, specific questions on which obstetricians knowledge, attitudes or recommendations varied with research-supported findings were identified, including questions regarding engorgement, avoiding certain foods while breastfeeding and the use of oral contraception while breastfeeding. The need for continuing medical education concerning breastfeeding physiology, promotion, and management was stressed.
EFFECTS OF PRENATAL NUTRITION COUNSELING ON DIETARY INTAKE. A.L. Yarbro, MS, RID, M.L. Dundas, PhD, RD, P.D. Connor, PhD, R.R. Roach, EdD, RD, and M. Murphy, MS, RD, Department of Family Medicine, University of Tennessee, Memphis, TN. Inadequate dietary intake of the mother has been identified numerous times as a primary determinant of poor pregnancy outcomes. The purpose of this study was to determine the effect of dietary counseling on the nutrient intake of pregnant women. The study population consisted of 31 family practice obstetrical patients, ages 16 to 37. A 24 hour dietary recall, changes in diet form, and questionnaire were completed by the nutritionist and patient at the initial and follow-up appointments. Each patient received advice on appropriate dietary intake for pregnancy and returned for at least one follow-up appointment. Total kilocalories, protein, carbohydrate, fat, calcium, iron, and folacin were determined for each participant prior to and following nutrition counseling. A repeated measures test was used to determine if nutrition counseling had a significant effect on nutrient intake. Patients averaged 48% of their kcalories from carbohydrates, 36% from fat, and 16% from protein. Study participants with an income below poverty level, • $12,000/year, had a significantly higher caloric intake after counseling (P<.05), while those with incomes over $12,000/year had a significantly higher caloric intake prior to counseling. Women in the higher income group had a significantly lower intake of folacin subsequent to counseling. Participants who reported exercising consumed a higher percent of kcalories from carbohydrates and a lower percent of kcalories from fat in the post-counseling diets. Foods that were consumed more during pregnancy were citrus fruits and juices, other fruits, and milk and dairy products; foods consumed less often were diet drinks, salty snacks, candy, and soft drinks. Although this study demonstrated modest improvements in diet, a consistent nutrition message by physicians, nursing staff, and dietitians could be more effective in improving dietary intake.
CAN THE HEALTHY PEOPLE 2000 NUTRITION OBJECTIVE FOR BREASTFEEDING BE ACHIEVED? S.L. Gartner, RD, S.B. Clark, RD, MidMichigan Regional Medical Center, Midland, MI The Lactation Support Service at MidMichigan Regional Medical Center (MRMC)was developed to maximize the success of the breastfeeding mother. The program focuses on the needs of the nursing dyad and has evolved into an integrated program of inpatient care, lactation education and outpatient follow-up. An interdisciplinary team of 3 registered dietitians, 2 registered nurses, 1 health educator, and a medical director bring together clinical expertise in different areas to help the mother and baby initiate appropriate feeding techniques, understand normal infant feeding patterns and to remove barriers to continued breastfeeding. This early intervention leads to earlier assessment and resolution of problems that would otherwise result in early weaning. The Healthy People 2000 Objective 2.11 targets are 75% nursing at discharge and 50% still nursing at 5-6 months postpartum. The baseline used for the objective was 54% nursing at discharge and 21% nursing at 5-6 months. MRMC has averaged 67.8% nursing at discharge from 1987-1992, and 48.3% nursing at 5-6 months. The targets appear to be attainable for our population. New approaches need to be found to impact the number of patients choosing to breastfeed. The program continues to evaluate the type of support needed to maintain at least 50% still nursing at 5-6 months. The registered dietitian is uniquely qualified to help families to make an informed decision about feeding their infants. Registered dietitians in tandem with other health professionals can promote breastfeeding with positive results.
A-20 / SEI1'TEIMBER 1993 SUPILEMENT VOLUME 93 NUMBER 9
PENNSYLVANIA OBSTETRICIANS' KNOWLEDGE, ATTITUDES, AND RECONMENDATIONS ABOUT BREASTFEEDING. J.A. Lohr, MS, RD, and S.S. Dahlheimer, PhD, RD, Department of Food & Nutrition, Indiana University of Pennsylvania, Indiana, PA. The benefits of breastfeeding are widely recognized by most health care professionals. However, the percent of women in the United States who breastfeed their infants and the duration of time they breastfeed have decreased in recent years, in spite of established goals for breastfeeding of 75% at hospital discharge, and at least 35% continuing at five to six months post-partum. One major barrier to increased breastfeeding rates identified by the Surgeon General's report was the lack of knowledge and support by health care professionals. Obstetricians have been noted to be a primary source of information and support for women in the decision of infant feeding method, having direct and ongoing contact during the prenatal period. The purpose of this study was to investigate Pennsylvania obstetricians' knowledge, attitudes and recommendations concerning breastfeeding. thirty item survey instrument was mailed to 436 obstetricians who were registered with the Pennsylvania Medical Society. For the purpose of statistical analyses, 147 (34%) of the 171 returned surveys were usable, 96% of which were completed by the physician. The responses given were compared with current research supported by the literature. Mean scores for knowledge, attitudes, and recommendations were 74%, 81%, and 79%, respectively. Data were also analyzed to identify any significant differences in knowledge, attitudes, or recommendations with respect to age, gender, location of practice, and year of graduation from medical college. A statistically significant difference (=.002) was found between knowledge scores with respect to the obstetrician's age. Specifically, those between the ages of 30 to 39 years and 40 to 49 years scored significantly better than those 50 to 59 years of age. However, no significant differences were found with respect to gender, location of practice, or year of graduation. Finally, specific questions on which obstetricians knowledge, attitudes or recommendations varied with research-supported findings were identified, including questions regarding engorgement, avoiding certain foods while breastfeeding and the use of oral contraception while breastfeeding. The need for continuing medical education concerning breastfeeding physiology, promotion, and management was stressed.
EFFECTS OF PRENATAL NUTRITION COUNSELING ON DIETARY INTAKE. A.L. Yarbro, MS, RID, M.L. Dundas, PhD, RD, P.D. Connor, PhD, R.R. Roach, EdD, RD, and M. Murphy, MS, RD, Department of Family Medicine, University of Tennessee, Memphis, TN. Inadequate dietary intake of the mother has been identified numerous times as a primary determinant of poor pregnancy outcomes. The purpose of this study was to determine the effect of dietary counseling on the nutrient intake of pregnant women. The study population consisted of 31 family practice obstetrical patients, ages 16 to 37. A 24 hour dietary recall, changes in diet form, and questionnaire were completed by the nutritionist and patient at the initial and follow-up appointments. Each patient received advice on appropriate dietary intake for pregnancy and returned for at least one follow-up appointment. Total kilocalories, protein, carbohydrate, fat, calcium, iron, and folacin were determined for each participant prior to and following nutrition counseling. A repeated measures test was used to determine if nutrition counseling had a significant effect on nutrient intake. Patients averaged 48% of their kcalories from carbohydrates, 36% from fat, and 16% from protein. Study participants with an income below poverty level, • $12,000/year, had a significantly higher caloric intake after counseling (P<.05), while those with incomes over $12,000/year had a significantly higher caloric intake prior to counseling. Women in the higher income group had a significantly lower intake of folacin subsequent to counseling. Participants who reported exercising consumed a higher percent of kcalories from carbohydrates and a lower percent of kcalories from fat in the post-counseling diets. Foods that were consumed more during pregnancy were citrus fruits and juices, other fruits, and milk and dairy products; foods consumed less often were diet drinks, salty snacks, candy, and soft drinks. Although this study demonstrated modest improvements in diet, a consistent nutrition message by physicians, nursing staff, and dietitians could be more effective in improving dietary intake.
CAN THE HEALTHY PEOPLE 2000 NUTRITION OBJECTIVE FOR BREASTFEEDING BE ACHIEVED? S.L. Gartner, RD, S.B. Clark, RD, MidMichigan Regional Medical Center, Midland, MI The Lactation Support Service at MidMichigan Regional Medical Center (MRMC)was developed to maximize the success of the breastfeeding mother. The program focuses on the needs of the nursing dyad and has evolved into an integrated program of inpatient care, lactation education and outpatient follow-up. An interdisciplinary team of 3 registered dietitians, 2 registered nurses, 1 health educator, and a medical director bring together clinical expertise in different areas to help the mother and baby initiate appropriate feeding techniques, understand normal infant feeding patterns and to remove barriers to continued breastfeeding. This early intervention leads to earlier assessment and resolution of problems that would otherwise result in early weaning. The Healthy People 2000 Objective 2.11 targets are 75% nursing at discharge and 50% still nursing at 5-6 months postpartum. The baseline used for the objective was 54% nursing at discharge and 21% nursing at 5-6 months. MRMC has averaged 67.8% nursing at discharge from 1987-1992, and 48.3% nursing at 5-6 months. The targets appear to be attainable for our population. New approaches need to be found to impact the number of patients choosing to breastfeed. The program continues to evaluate the type of support needed to maintain at least 50% still nursing at 5-6 months. The registered dietitian is uniquely qualified to help families to make an informed decision about feeding their infants. Registered dietitians in tandem with other health professionals can promote breastfeeding with positive results.
A-20 / SEI1'TEIMBER 1993 SUPILEMENT VOLUME 93 NUMBER 9