The Relationship between Pregnancy Planning and Breastfeeding Duration

This exploratory study, using a convenience sample of 102 primiparous women in New Zealand, examined the relationship between pregnancy planning and duration of breastfeeding. These women, who had chosen to exclusively breastfeed their infants, responded to a two-part survey: Part I self administered on the day of discharge from hospital; Part II completed during a telephone interview at 6 weeks postpartum. Results: No relationship was found between planning of pregnancy and duration of exclusive breastfeeding. At 6 weeks postpartum, 66 (65%) were exclusively breastfeeding and 34 (35%) were not. Women who had completed 12 grade were significantly more likely to exclusively breastfeed at 6 weeks postpartum than women who had not completed high school (X= 5.38, p = 0.02). Conclusions: Although a relationship between planning of pregnancy and breastfeeding has been found in previous studies in the United States, it was not found in this small and potentially unrepresentative group of breastfeeding women in one New Zealand setting. One reason may have been that all the women in this study had already chosen to breastfeed. The relationship between level of education and exclusive breastfeeding at 6 weeks is not well recognised. Further research is recommended to address the issue of increased breastfeeding support for women with lower levels of education. Introduction An influential article published by Saadeh and Akre in 1996 asserted that: “breast-feeding is as important to the health of children in industrialized countries as it is to children in developing countries. Scientific evidence demonstrates the incomparable benefits of breast-feeding in all environments, including highly sophisticated industrialized countries. Morbidity (disease) and mortality (death) are always higher among artificially-fed than among breast-fed infants” (p.156). This evidence was the reason that the World Health Organization (WHO) and the United Nations International Children’s Fund (UNICEF) established the Baby Friendly Hospital Initiative (BFHI) in 1991. The goal of the BFHI is to increase breastfeeding rates globally through maternity practices that encourage and promote breastfeeding (UNICEF, 1999). Given the numerous, well documented health benefits of breastfeeding for both women and their infants (Beral, Bull, Doll, Peto & Reeves, 2001; Newman, 1995; Newman, 1999; Riordan. & Auerbach, 1999; Saadeh & Akre, 1996), it is important that midwives are aware of those factors that may interfere with a woman’s decision to breastfeed. In the United States, the Committee on Unintended Pregnancy (1995) established that an association exists between a woman’s intention to become pregnant and her health-related behaviours. The relationship between unplanned pregnancy and breastfeeding behaviours has received attention in two large studies that were conducted in the United States (Dye, Wojtowycz, Aubrey, Quade & Kilburn, 1997; Kost, Landry & Darroch, 1998). Dye et al. obtained data on 27,700 of the 33,735 women who delivered live babies in central New York State between January 1, 1995, and July 31, 1996. Kost et al. obtained data from 11,670 women in 1998. Results of both studies indicated that unplanned pregnancies significantly reduced the probability that women would breastfeed their newborns. However, these studies addressed only the intent to breastfeed and not ongoing breastfeeding behaviours. The purpose of the New Zealand study was to explore this question further. Specifically, this exploratory study focused on whether planning of pregnancy also affects the duration of breastfeeding in women who have already made the choice to breastfeed. Methodology Sample and setting The study design was a two-part survey administered to a convenience sample of 105 primiparous women who experienced a normal vaginal birth and who intended to breastfeed. The appropriate regional ethics committee provided ethical approval for the study. The women were approached and invited to participate by a midwife researcher in the postnatal ward of a New Zealand hospital in June, July and August of 2001. All women agreed to participate and 102 completed both parts of the study. The women were aged between 16 and 40 with 73% Pakeha, 13 % Mäori, 8% Pacific Island, and 6% of other ethnic background. Ethnicity was self described by each participant. This sample is dissimilar to the ethnicity of the total population of NZ women as described in the Ministry of Health Report on Maternity:1999, where 58% were Pakeha, 19% Mäori, 10.1% Pacific Island, 5.9% Asian, and 4.6% other. This may limit the generalisability of the study findings. Methods The first survey was completed in the hospital upon day of discharge. This consisted of a brief The relationship between pregnancy planning and breastfeeding duration MaryAnne Levine RN SCM MSN Health Educator PhD(c) Currently Professor of Childbearing Health at Humboldt State University, California. MaryAnne has worked extensively in the developing world with poor childbearing women of poverty and she has developed an immersion programme for North American Baccalaureate nursing students to work in developing countries. Joan Edelstein RN MSN DrPH Currently Professor of Maternity Nursing (Emerita) at Oakland, California. Joan has had 35 years experience in Maternal/Child Nursing in the United States including over 20 years as a Professor of Maternity Nursing at San Jose State University in California. Maralyn Foureur RGON RM BA Grad Dip Clin Epid PhD Currently Clinical Professor and Director of the Collaborating Centre for Midwifery and Nursing Education, Practice and Research at Capital and Coast District Health Board and Graduate School of Nursing and Midwifery, Victoria University of Wellington, NZ. Maralyn has been a midwife for 30 years with 15 years spent in independent midwifery practice and 20 years in midwifery education and research. Contact for correspondence: levinem@humboldt.edu MaryAnne Levine, Joan Edelstein and Maralyn Foureur More studies need to be done to address issues related to variables that increase exclusive and successful breastfeeding and could explore what women of higher education levels have in place that might be provided for women of lower education levels.