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. 2023 Jan 12;13(1):e066978.
doi: 10.1136/bmjopen-2022-066978.

Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study

Tanisha Springall  1   2 , Della Anne Forster  3   4 , Helen L McLachlan  3 , Pamela McCalman  3 , Touran Shafiei  3
Affiliations

Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study

Tanisha Springall et al. BMJ Open. .

Abstract

Objectives: There is an urgent need to improve breast feeding rates for Australian First Nations (Aboriginal and Torres Strait Islander) infants. We explored breast feeding outcomes of women having a First Nations infant at three sites that introduced a culturally specific continuity of midwife care model.

Design: Women having a First Nations infant booking for pregnancy care between March 2017 and November 2020 were invited to participate. Surveys at recruitment and 3 months post partum were developed with input from the First Nations Advisory Committee. We explored breast feeding intention, initiation, maintenance and reasons for stopping and factors associated with breast feeding.

Setting: Three tertiary maternity services in Melbourne, Australia.

Participants: Of 479/926 eligible women approached, 343 (72%) completed the recruitment survey, and 213/343 (62%) the postnatal survey.

Outcomes: Primary: breast feeding initiation and maintenance. Secondary: breast feeding intention and reasons for stopping breast feeding.

Results: Most women (298, 87%) received the culturally specific model. Breast feeding initiation (96%, 95% CI 0.93 to 0.98) was high. At 3 months, 71% were giving 'any' (95% CI 0.65 to 0.78) and 48% were giving 'only' breast milk (95% CI 0.41 to 0.55). Intending to breast feed 6 months (Adj OR 'any': 2.69, 95% CI 1.29 to 5.60; 'only': 2.22, 95% CI 1.20 to 4.12), and not smoking in pregnancy (Adj OR 'any': 2.48, 95% CI 1.05 to 5.86; 'only': 4.05, 95% CI 1.54 to 10.69) were associated with higher odds. Lower education (Adj OR 'any': 0.36, 95% CI 0.13 to 0.98; 'only': 0.50, 95% CI 0.26 to 0.96) and government benefits as the main household income (Adj OR 'any': 0.26, 95% CI 0.11 to 0.58) with lower odds.

Conclusions: Breast feeding rates were high in the context of service-wide change. Our findings strengthen the evidence that culturally specific continuity models improve breast feeding outcomes for First Nations women and infants. We recommend implementing and upscaling First Nations specific midwifery continuity models within mainstream hospitals in Australia as a strategy to improve breast feeding.

Keywords: NEONATOLOGY; OBSTETRICS; PRIMARY CARE.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Participant recruitment.
See this image and copyright information in PMC

References

    1. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475–90. 10.1016/S0140-6736(15)01024-7 - DOI - PubMed
    1. United Nations Children’s Fund . Innocenti Declaration 2005. In: UNC F, ed. United Nations Children’s Fund, 2005.
    1. World Health Organization . Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services; 2017. - PubMed
    1. National Health and Medical Research Council . Eat for health. infant feeding guidelines. information for health workers. Canberra, 2012.
    1. Australian Institute of Health and Welfare . 2010 Australian National infant feeding survey: indicator results: Australian Institute of health and welfare; 2012.

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