Influence of nurses' knowledge, attitudes, and counseling practices on breastfeeding outcomes: A Philadelphia case study

Background: Nurses and midwives are in a prime position to provide mothers with valuable information and support; however, they can vary considerably in their knowledge of breastfeeding practices and their displays of support and encouragement of breastfeeding. Objective: A cross-sectional study was conducted to evaluate the effect of nurses' knowledge, attitudes, and counseling practices on breastfeeding outcomes in Philadelphia hospitals. Methods: Data was collected from 105 nurses and midwives from obstetric units of two Philadelphia teaching hospitals using a self-administered questionnaire assessing infant feeding practices in the unit, knowledge of effective breastfeeding practices and physiology, attitudes towards breastfeeding, and beliefs towards unit practices. Multivariate logistic regression was used to obtain adjusted odds ratios. Results: The majority of participants promoted exclusive breastfeeding (70.5%; n=74) however, many also reported the use of supplements (51.4%; n=54) and distribution of formula discharge packs (47.6%; n=50). Nurses with low attitude scores were six times more likely to send mothers home with a formula pack than nurses with higher scores (OR=6.08, 95% CI: 1.46-25.29). Additionally, nurses with positive perceptions of formula were twice as likely to not promote exclusive breastfeeding, compared to nurses with neutral or negative perceptions (OR=2.00, 95% CI: 1.17-3.42). Conclusion: Nurses' attitudes have implications for the maintenance of exclusive breastfeeding. Also, a more effective approach to increasing the prevalence of exclusive breastfeeding should focus on emphasizing the pitfalls of using formula as well as the benefits of breast milk.