Provider Type and Exclusive Breastfeeding, New York City, 2009-10

The low rates of exclusive breastfeeding in low-income non-Hispanic Black and Hispanic women have been well documented.  Breastfeeding education has been shown to improve rates indicating that provider type may play a role.  With the expansion of Medicaid reimbursement to midwives under the Affordable Care Act, it is essential to examine the role of midwives in breastfeeding, particularly for low-income minority women.  A sample of singleton births between 2009-10 (n=136854) was utilized to examine the association between provider type and exclusive breastfeeding in the hospital before discharge.  Provider type was defined as a physician-led or midwife-led model.  A midwife-led model indicated receiving prenatal care from a nurse midwife, nurse practitioner, or physician’s assistant with a midwife attending the birth; physician-led indicated that a physician provided prenatal care and attended the birth.  9% of women utilized a midwife-led model and were more likely to be Hispanic and using Medicaid.  Women with a midwife-led model were significantly more likely to exclusively breastfeed as compared to the physician-led model (55.8% vs 37.9%, p<0.0001).  In particular, NH Black and Hispanic women were 67% more likely to exclusively breastfeed if they utilized a midwife-led model.  In the adjusted model estimating prevalence ratios, women with a midwife-led model were 50% more likely to exclusively breastfeed as compared to those with a physician-led model (APR=1.50, 95% CI 1.48-1.52).  Similar results were seen in all race/ethnicity groups.  These findings indicate the need to examine the role of provider in promoting exclusive breastfeeding while minimizing medical expenditures.