Can Childcare Workers Impact Breastfeeding Rates? An operational research study

Background/Purpose: Due to lack of paid maternity leave, most women in the US re-enter the workforce within weeks to months postpartum. Many women incorrectly assume that breastfeeding must stop when they work and their infant enters childcare. The question addressed is how to best inform women that they may continue breastfeeding. To study this issue, we are working with childcare in Wake County to assess and address gaps in knowledge, attitudes and practices (KAP) related to feeding. Methods/Data: This study uses multiple designs to identify possible entry points to improve breastfeeding support in the daycare setting. Childcare workers completed an IRB-approved KAP questionnaire, and the directors completed a self-assessment instrument. In addition, key informant interviews were held with WIC peer counselors. A phased operational research design is employed, with systematic assignment of centers based on size, acceptance of vouchers and quality rating, to ensure that the early intervention and late intervention groups are comparable. Outcomes to be assessed are changes in KAP and breastfeeding rates. Findings: Descriptive statistics reveal that daycare workers' KAP includes minor and significant gaps related to breastfeeding support. These findings have been used to develop a set of materials for childcare workers, families and other healthcare providers, to better inform families on feeding in daycare, and to support continuation of breastfeeding. Conclusions: Despite national and state guidelines, many childcare workers have poor KAP related to breastfeeding. The interventions based on these findings may increase the support needed for breastfeeding success after return to work.