{"title":"The role of nurses, midwives, and doulas on breastfeeding: changes during the COVID-19 pandemic.","authors":"Shubhecchha Dhaurali, Shikhar Shrestha","doi":"10.3389/fgwh.2025.1469428","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic has significantly altered maternal healthcare delivery, including breastfeeding practices. Our study investigated the influence of nurses, midwives, and doulas on breastfeeding education and rates, with a specific focus on changes that transpired during the COVID-19 pandemic.</p><p><strong>Methods: </strong>Using a cross-sectional design, we performed a secondary data analysis on a stratified systematic sample of forty-six U.S. states and New York City respondents who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 (2012-2015) and Phase 8 (2016-2020) surveys (<i>n</i> = 193,068). Descriptive analyses and adjusted multivariable logistic regression models reporting adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were used to assess associations between the provision of breastfeeding guidance to mothers from nurses, doulas, or midwife healthcare professionals; breastfeeding/pumping rates; and the COVID-19 pandemic. Cox-proportional hazard models were used to examine the association between breastfeeding guidance and breastfeeding duration.</p><p><strong>Results: </strong>Our findings revealed that participants who received breastfeeding guidance from nurses, midwives, or doulas were twice as likely to have engaged in breastfeeding or milk pumping for their infants than participants who did not receive breastfeeding education (aOR = 1.99, 95% CI: 1.89-2.11, <i>p</i> < 0.0001). Additionally, participants who gave birth during the COVID-19 pandemic were notably less likely to receive breastfeeding education from a nurse, midwife, or doula than were those who gave birth before the pandemic (aOR = 0.92, 95% CI: 0.88-0.96, <i>p</i> < 0.0001). We also find that the hazard of stopping breastfeeding was lower among participants who received breastfeeding guidance (HR = 0.94, 95% CI: 0.91-0.97, <i>p</i> < 0.0001). Additionally, the hazard of stopping breastfeeding was lower during COVID-19 (HR = 0.94, 95% CI: 0.91-0.97, <i>p</i> = 0.001).</p><p><strong>Discussion: </strong>Our study underscores the vital role that healthcare professionals play in educating, advocating for, and promoting breastfeeding behaviors. This further highlights the pressing need for sustained efforts to support breastfeeding initiatives and address disparities in maternal and child health, particularly in the context of the challenges presented by the COVID-19 pandemic.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1469428"},"PeriodicalIF":2.3000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034719/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in global women's health","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3389/fgwh.2025.1469428","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: The COVID-19 pandemic has significantly altered maternal healthcare delivery, including breastfeeding practices. Our study investigated the influence of nurses, midwives, and doulas on breastfeeding education and rates, with a specific focus on changes that transpired during the COVID-19 pandemic.
Methods: Using a cross-sectional design, we performed a secondary data analysis on a stratified systematic sample of forty-six U.S. states and New York City respondents who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 (2012-2015) and Phase 8 (2016-2020) surveys (n = 193,068). Descriptive analyses and adjusted multivariable logistic regression models reporting adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were used to assess associations between the provision of breastfeeding guidance to mothers from nurses, doulas, or midwife healthcare professionals; breastfeeding/pumping rates; and the COVID-19 pandemic. Cox-proportional hazard models were used to examine the association between breastfeeding guidance and breastfeeding duration.
Results: Our findings revealed that participants who received breastfeeding guidance from nurses, midwives, or doulas were twice as likely to have engaged in breastfeeding or milk pumping for their infants than participants who did not receive breastfeeding education (aOR = 1.99, 95% CI: 1.89-2.11, p < 0.0001). Additionally, participants who gave birth during the COVID-19 pandemic were notably less likely to receive breastfeeding education from a nurse, midwife, or doula than were those who gave birth before the pandemic (aOR = 0.92, 95% CI: 0.88-0.96, p < 0.0001). We also find that the hazard of stopping breastfeeding was lower among participants who received breastfeeding guidance (HR = 0.94, 95% CI: 0.91-0.97, p < 0.0001). Additionally, the hazard of stopping breastfeeding was lower during COVID-19 (HR = 0.94, 95% CI: 0.91-0.97, p = 0.001).
Discussion: Our study underscores the vital role that healthcare professionals play in educating, advocating for, and promoting breastfeeding behaviors. This further highlights the pressing need for sustained efforts to support breastfeeding initiatives and address disparities in maternal and child health, particularly in the context of the challenges presented by the COVID-19 pandemic.
2019冠状病毒病大流行显著改变了孕产妇保健服务,包括母乳喂养做法。我们的研究调查了护士、助产士和助产师对母乳喂养教育和率的影响,特别关注了COVID-19大流行期间发生的变化。方法:采用横断面设计,对美国46个州和纽约市完成妊娠风险评估监测系统(PRAMS)第7期(2012-2015年)和第8期(2016-2020年)调查的受访者(n = 193,068)进行分层系统样本的二次数据分析。使用描述性分析和校正多变量logistic回归模型报告校正优势比(aORs)和95%置信区间(95% ci)来评估护士、助产师或助产士医疗保健专业人员向母亲提供母乳喂养指导之间的关联;母乳喂养/泵送率;以及COVID-19大流行。使用cox -比例风险模型来检验母乳喂养指导与母乳喂养持续时间之间的关系。结果:我们的研究结果显示,接受护士、助产士或助产师母乳喂养指导的参与者为婴儿进行母乳喂养或吸奶的可能性是未接受母乳喂养教育的参与者的两倍(aOR = 1.99, 95% CI: 1.89-2.11, p p p p = 0.001)。讨论:我们的研究强调了医疗保健专业人员在教育、倡导和促进母乳喂养行为方面发挥的重要作用。这进一步表明,迫切需要持续努力,支持母乳喂养举措,解决孕产妇和儿童健康方面的差距,特别是在2019冠状病毒病大流行带来挑战的背景下。