This spring's session of the Rural Health School at the Paynesville Area Health Care System (PAHCS) drew to a close last week with the presentation of their community project on breast-feeding awareness.
Participating in the school and doing the project were: Erin Osborne, a third-year medical student at the University of Minnesota who is spending nine months in Paynesville under the Rural Physician Associate Program; and Ruth Klatt, a doctor of pharmacy student at the University of Minnesota who was here just for the ten-week Rural Health School.
The idea for their project topic came from Nell Fuchs, a nurse who directs prenatal courses at PAHCS. Klatt said it was identified as an area that the health care system could improve on.
Their plan was to use a survey to identify trends in the community and by health care providers. Then they wanted to provide resources to expectant and new mothers to promote breast-feeding awareness.
They sent out 174 surveys, to every woman who had delivered a baby at the hospital in the past two years. They received 82 surveys in reply, 47 percent of the total. Of the women who replied, 72 percent had breast fed their most recent child. A potential bias in the survey, Osborne and Klatt speculated, may have been that mothers who did not breast-feed may have felt health care providers supported breast-feeding and didn't respond to the survey.
"The purpose of the survey was to see who breast-feeds and who doesn't and to identify any trends," explained Klatt.
Significant differences between women who had and had not breast-fed were previous experience and whether she planned to breast-feed before delivery. Of the mothers who breast-fed, two-thirds had also done it for a previous child. Even more dramatically, 98 percent of breast-feeding mothers had planned to do it before giving birth.
Sixteen percent of the mothers who did not breast-feed had planned to do it before delivery, but had not done it.
Their conclusions from the survey were:
*The most common reason why mothers do not breast-feed is personal preference, followed by work or school obligations.
*The most common reasons why mothers choose to breast-feed are advantages to the baby, advantages to the mother, cost, and medical staff recommendations.
*The most common reasons why mothers stop breast-feeding are returning to work or school, the baby's age, and discomfort or pain.
*The people who most influenced mothers to breast-feed were a significant other, a primary doctor, the family, and a prenatal instructor.
*The people or beliefs that least influenced mothers to breast-feed were religious beliefs, friends, and nurses.
"Basically, people are influenced by people around them," said Osborne. "We wanted to find out what influence health care system personnel had."
They were pleased with the prenatal influence of health care personnel, but identified an area of need in postnatal care. "A big obstacle for most mothers was the first couple of days after delivery," said Osborne. "The first week is the most difficult time for new mothers."
Many mothers started breast-feeding but quit. Osborne said professional support was crucial until new mothers get into a breast-feeding routine. She hoped to meet with the hospital nurses to discuss ways the health care system could be more supportive of mothers who are just starting to breast-feed.
The survey results will be available to interested health care providers.
In addition, Osborne and Klatt designed and published an informational brochure about breast-feeding. It gives reasons to breast-feed, answers common questions, and lists resources for breast-feeding mothers. Brochures are available in the clinic lobby and during prenatal doctor visits and at prenatal classes.
Two breast pumps will be purchased for the hospital to provide to breast-feeding moms who need one but cannot afford it.
"I think the students did a really good job," said Laura Odell, a doctor of pharmacy at the clinic who supervised the Rural Health School. The survey results, she said, included health care providers, family, friends, and significant others. Interdisciplinary study is one of the goals of the Rural Health School.
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