Study finds rural and regional women need more support to breastfeed

This article, originally published by RACGP, discusses obesity as being an associated  factor, even causative, however it is a multitude of other factors too which GPs can explore, unpack and address. Dr Simonis outlines how the lack of services in rural communities needs to be addressed.

Lactation consultants are not as accessible in rural communities, women with lower socioeconomic backgrounds are less likely to breast feed. Rural mothers need to be given the support and education around breast feeding, even before the baby arrives. It demonstrates the need for continuity of care, which can be provided through the GP,  but needs support from the community.

Telehealth is of great benefit here, as GPs can make  contact with new mothers  early on,  to encourage and support breast feeding.

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The health benefits of breastfeeding are well-established, with the World Health Organization recommending that infants be exclusively breastfed from within one hour of life until six months of age, and that it continue to form a part of their diet up to age two.

In Australia, breastfeeding initiation rates are high at 90%, and while rates have increased in regional communities, they are still lagging behind.

Now a new study, by La Trobe University, has identified a number of risk factors associated with low uptake.

Drawing on data from close to 7500 women who gave birth at a large Victorian regional hospital between 2010 and 2017, the authors noted lower initiation of breastfeeding among:

• women with a higher body mass index (BMI)
• teenage mothers
• women who smoke, or have a history of smoking
• women from a disadvantaged background

Women with obesity and morbid obesity were found to be 66% less likely to initiate breastfeeding than other women, while women with morbid obesity who also come from the most disadvantaged socio-economic groups were at most risk of not breastfeeding.

Lead author, Associate Professor Melanie Bish is Head of the Rural Department of Nursing and Midwifery at La Trobe Rural Health School.

She told newsGP that while the at-risk categories are not new when contrasted with global breastfeeding studies, it gives health professionals a greater understanding of the regional context – with the hope that it will lead to better targeted support.

‘Our study shows that whether or not a woman initiates breastfeeding can be based on a range of factors – both physiological and social – from how she feels about her body, to what her friendship group says,’ Associate Professor Bish said.

‘So we encourage health practitioners, including GPs, to discuss and educate, and support women around their intention to breastfeed whilst they’re pregnant.’

She says this targeted support has the potential for ‘huge long-term benefits’ for both mothers and babies.

The study notes the importance of ensuring access to services in regional communities, particularly in disadvantaged neighbourhoods, and also emphasises continuity of care.

Dr Magdalena Simonis, a GP and RACGP Fellow with a special interest in women’s health, agrees.

She told newsGP there is often a lack of support outside of major cities, and that many women are often unprepared for the common realities of breastfeeding.

‘A lot of women present in general practice [saying] “no one told me that breastfeeding would be so difficult”,’ she said.

‘They all expect it’s going to happen naturally, and there is this implication that breastfeeding is just a natural process and it should automatically be instigated.

‘So we need to start the conversation about breastfeeding before the baby arrives, rather than starting the conversation after the baby arrives, when there’s so much else happening.’

While the study found a clear association of low breastfeeding initiation among women with a high BMI, Dr Simonis said once the baby is born that the conversation should not be focused on weight.

‘[Instead] you really need to talk about their mental health and the mother baby bonding, and the benefits of breastfeeding,’ she said.

‘Also, from a cost perspective, if they’re coming from a lower socio economic background, they need to be aware that this is also a cheaper way of providing the support and the nutrition to their baby.

‘So it’s about follow up with a GP, and follow up in that initial six months on a regular basis, and we can use a combination of telehealth and face-to-face for that.’

Dr Simonis advises that once a patient’s GP becomes aware of the birth, that the doctor should take the initiative and reach out within the first week to offer support.

‘That’s a window of opportunity for us to pick up the phone and make contact with the new mother,’ she said.

‘Just make a list, pick up the phone and say “Hi, congratulations on the delivery of your baby. How are things going? Are you breastfeeding? You know that it’s a good idea. If you’re having any difficulties with it, why don’t you come in and we can talk about how we can support you through this phase”.

‘Telehealth is very useful here.’

Associate Professor Bish agrees that telehealth is a useful model, and says that care should be delivered as a multidisciplinary team, also drawing on lactation consultants where necessary.

‘The biggest thing that we really need to look for is intentional multidisciplinary care, so women don’t necessarily have to leave their communities to be able to access expertise,’ she said.

‘And that regional health service provision is quite creative in terms of utilising telehealth and other models across the journey, from pregnancy right through to post-partum care as well.’

Associate Professor Bish says a foundation of trust between the GP and the patient is crucial, both during pregnancy and postpartum.

‘Healthcare practitioners [need] to make sure that they are up-to-date with current practices and recommendations,’ she said.

‘But also too, that they feel that they have a level of confidence to approach this in a sensitive way, because it is a big decision for a woman.

‘That’s why, again, coming back to a really positive dynamic is essential so that women feel supported, and there’s no judgement.’

Originally published: racgp.org.au/newsgp/clinical/study-finds-rural-and-regional-women-need-more-sup