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Breastfeeding Experience Survey (BABES) Outcomes Through December 2011

Introduction

Learning about our patients is important so that we can tailor our education, clinical services and research to support breastfeeding until infants are at least one year old. This is especially important to us since, in 2011, there were an estimated 6,145 babies (ages 0-1 year old) new to PAMF.

The American Academy of Pediatrics recommends exclusive breastfeeding (breast milk with no solids or other liquids except vitamin/mineral supplements or medications) for the first six months of infancy, and then continued breastfeeding, along with the introduction of iron-rich foods, for at least the first year of an infant’s life.¹

In the United States, 80% of women indicate before delivery that they intend to breastfeed² and 75% initiate breastfeeding after delivery. Unfortunately, though, by the end of the baby’s first week half of the women have already given their infant formula, and at nine months only 31% are breastfeeding to any extent.³

Note: These results are not relevant for women who, for a variety of reasons, cannot breastfeed (or solely breastfeed) their babies. We still encourage these women to participate and share their experiences, so that we can develop more support services for women who 1) don't produce enough milk, 2) have health/medical issues that prevent breastfeeding, 3) have a baby in the NICU who needs supplements, 4) have a baby who does not latch (even with help from a variety of lactation consultants), or 5) cannot breastfeed for other reasons.

Disclaimer: These outcomes are provided for your general information and education only, and should NOT be relied upon for personal diagnosis or treatment. All data compiled for this project comes from a small number of Palo Alto Medical Foundation patient volunteers, and therefore may not be representative of all populations. If you have questions, please contact your health care provider.

Outcomes

In honor of National Breastfeeding Week (the first week of August each year) we provide the following snapshot of the breastfeeding habits of the PAMF patients participating in the Bay Area Breastfeeding Experience Survey (BABES) project.

These results are not comprehensive, only highlights of what we are learning, and will be updated regularly.

Summary of Outcomes

• Demographics of BABES Survey Participants
• Breastfeeding: BABES Participants vs. U.S. Average
• Intentions to Breastfeed
• Impact of OB/GYN Opinion
• Prenatal Class Attendance
• The Birth Experience & First Two Weeks
• Formula Use
• Jaundice
• Pumping Breast Milk
• Work & Breastfeeding
• Child Care
• Sleeping Habits
• Stopping Breastfeeding
• Reasons Why Moms Stopped Breastfeeding
• Key Factors for Breastfeeding through 12 Months

Demographics of BABES Survey Participants

As you can see below, BABES participants come from all three regions of PAMF and many of the BABES participants are over 30, Caucasian, hold at least one college degree, work outside the home, and are first-time moms.

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Breastfeeding: BABES Participants vs. U.S. Average

The table and figure below describe rates of any as well as exclusive breastfeeding by age among BABES participants and U.S. women. The statistics reflect the fact that BABES participants are breastfeeding more than the U.S. average at every age.

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Intentions to Breastfeed

BABES participants’ intended length of breastfeeding did not change dramatically after giving birth, although there is an increase in women planning to breastfeed until their baby is older than 13 months (from 29% at birth to 33% at 1 month).

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Impact of OB/GYN Opinion

Women who know their OB/GYN recommends breastfeeding only, without formula, are more likely to plan to breastfeed for at least 12 months, and are also much more confident that they can meet their breastfeeding goal.

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Prenatal Class Attendance

At PAMF, we offer both childbirth preparation and breastfeeding classes. As you can see below, both were attended more by first time parents than by parents who already had at least one child. Our goal is to develop support systems for parents who do not attend these classes, once we understand why they do not.

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The Birth Experience & First Two Weeks

BABES participants had a variety of experiences with the birth process. When asked to specify all interventions their births included, BABES participants outlined 707 experiences. The top eight interventions are listed in Table 3.

Table 3. Top eight interventions occurring during the birth process for BABES participants (as of December 5, 2011).

Did your birth include? (N=276)	Count of "Yes"
An epidural	173 (63)
A vaginal tear	122 (44%)
Induction	94 (34%)
Pain medication (Demerol, Stadol or Fentanyl)	81 (29%)
A spinal	48 (17%)
More than 20 hours of labor	46 (17%)
More than two hours of pushing	32 (12%)
An episiotomy	27 (10%)

Within the first two weeks of giving birth, BABES participants experienced a number of problems with breastfeeding, as described in Figure 7.


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Formula Use

According to a recent CDC report⁴, 50% of breastfed children in the United States are supplemented with infant formula before six months of age. What is interesting about the BABES data is that more than double the percentage of PAMF babies are receiving formula supplements at birth than the U.S. average!

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Jaundice

Out of a total of 254 participants, 98 moms specified that their child had jaundice at some point before the baby was one month of age. Of the babies who had jaundice, 75% continued to nurse.

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Pumping Breast Milk

Out of a total of 246 participants, 173 moms specified that they were pumping for breast milk when their child was 3 months old. Participants reported a variety of reasons, the most common being they wanted other people to be able to feed the baby and/or they returned to work. Women pumping the most frequently were likely doing so to increase their milk supply.

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Work & Breastfeeding

Before birth, BABES participants are more likely to plan to breastfeed until the baby is older than 13 months if they are not intending to return to work in the baby’s first year.

As you can see in Figure 13, although there is no statistically significant correlation between moms returning to work and stopping breastfeeding, moms who had stopped breastfeeding were more likely to have worked in the previous four weeks.



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Child Care

The majority of participants reported that if someone else had cared for the baby during the previous four weeks, it had been primarily the other parent or grandparent at younger ages. As the babies age, there is a gradual shift towards non-family members caring for the children more hours a week.

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Sleeping Habits

Most BABES participants have their babies sleeping in the parent's bedroom until about six months of age, and the number of babies that sleep with their parents increases steadily as the babies age, suggesting together facilitates breastfeeding.

*Responses are not unique

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Stopping Breastfeeding

Out of a total of 338 participants, 107 women have reported ending their breastfeeding experience. Of those 107 women, 81 (76%) continued breastfeeding until their babies were at least six months old. The American Academy of Pediatrics recommends that babies be exclusively breastfed for about the first six months of life and continue to be breastfed until 12 months of age.

Figure 15 below shows that many mothers who have quit breastfeeding before the baby was 12 months did not want to stop when they did. In contrast, the majority of moms who stopped after 13 months were content to do so at the age.



The reluctance to stop breastfeeding is also reflected in Figure 16. This figure shows that many women expected to nurse for at least six months and were likely to actually do that; however, there were some women who had planned to nurse for at least 4-6 months but stopped at less than three months, likely for reasons they could not control.



As you can see in Figure 17, there is no clear correlation between use of a pacifier and length of time a baby is breastfed.


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Reasons Why Moms Stopped Breastfeeding

As you can see below in Table 6, the most significant reasons (means closest to 4.00) specified by BABES participants for why they stopped breastfeeding included: not have (or being able to pump) enough milk; baby lost interest; pumping no longer seemed worth the effort; and breast milk alone did not satisfy the baby. The most common reasons also vary by age.

The mean is calculated from the following:
Not at all important = 1
Not very important = 2
Somewhat important = 3
Very important = 4

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Key Factors for Breastfeeding through 12 Months

As of January 13, 2012, 150 women had filled out the 12 Month BABES survey. Of these 150 women, 108 of them (72%) managed to breastfeed up to and/or beyond the one year mark. When asked to describe what key factors helped them make it to this milestone, moms outlined the reasons summarized in Table 7. The top three reasons described were: mom’s commitment and determination to continue breastfeeding; support from husband, family and friends; and support in the workplace.

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Footnotes

₁GartnerLM, MortonJ, LawrenceRA, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115:496-506.
₂Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to mothers II: Report of the Second National US Survey of Women’s Childbearing Experiences. New York, NY: Childbirth Connection; 2006.
₃DC. Breastfeeding among US children born 2000-2008, CDC National Immunization Survey. Atlanta, GA: US Department of Health and Human Services, CDC, 2010. Available at: http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm. Accessed July 28, 2011.
₄CDC. Breastfeeding among US children born 2000-2008, CDC National Immunization Survey. Atlanta, GA: US Department of Health and Human Services, CDC, 2010. Available at: http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm. Accessed July 28, 2011.

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