New Moms Cite Lack Of Advice From Docs On Key Issues: Sleeping, Breastfeeding

After I gave birth to my kids, I was bombarded with advice from family, bestselling books and even strangers on topics ranging from how to lose the baby weight, when to have sex again and which infant toys boost IQ.

But according to a new, NIH-funded study, many sleep-deprived, hormone-addled new mothers may not be getting enough advice on critical issues from a most important source: doctors and other health care providers.

When it comes to breastfeeding, infant sleep position, immunization and pacifier use, many new moms report they get no advice at all from their children's doctors -- despite medical evidence on the benefits of certain practices, like breastfeeding and placing babies on their backs for sleep.

The new study — published in the journal Pediatrics and conducted by researchers at Boston Medical Center, Boston University and Yale University — found that about 20 percent of mothers said they didn't receive advice from their baby's doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. And more than 50 percent of mothers told investigators that doctors did not offer guidance on where the babies should sleep.

(Of course the whole issue of where newborns should sleep is controversial. Official recommendations now say babies should "room share" with parents but not "bed share.")

The study, part of a larger national effort called SAFE (Studies of Attitudes and Factors Effecting Infant Care Practices), surveyed more than 1,000 new mothers across the country, inquiring about infant care advice they received from different sources: doctors, nurses, family members and the media.

Dr. Staci Eisenberg, a pediatrician at Boston Medical Center and lead author of the new study, said in an interview that the number of moms who reported no advice from across the board is surprising.

"These findings say to me, 'Hmm, this is a time to stop and think carefully about how we communicate, and are we communicating in a clear, specific enough way, and are we being heard, especially by new moms — new parents — who are often tired and likely overwhelmed?' " she said. "Amidst this sea of information, what are the messages that need to be highlighted and communicated clearly?"

Of course, the study relied on self-reported data from new mothers caring for 2- to 6-month-old babies, so caveats are in order. Still, the authors suggest several reasons that health professionals may hold back:

There are a variety of reasons that potential advisers may not give advice or may give advice inconsistent with recommendations. These reasons may include lack of knowledge of the recommendations, a perception of controversy surrounding the recommendations, or actual disagreement with the recommendations. It is possible that some health professionals may choose to avoid controversy or a lengthy conversation about potentially controversial guidelines during a busy, time-pressured practice.

Dr. Melissa Bartick, an assistant professor of medicine at Harvard Medical School and internist at Cambridge Health Alliance, who has written extensively on infant bed sharing, says the new study is "impressive." But, she says, since the current recommendations on breastfeeding and sleep position "are not controversial at all (unlike sleep location and pacifiers)" the findings are a little troubling. In an email, Bartick, who was not involved in the study, writes:

"Doctors score incredibly low on breastfeeding and yet other studies show that their advice about breastfeeding is powerful. Hospital nurses do better, but still low. Sizeable portions of doctors and nurses give advice inconsistent with recommendations about breastfeeding.

The doctors and nurses scores on sleep position is even worse than for breastfeeding, with even lower appropriate advise and even higher inappropriate advice. There should not be any inappropriate advice, for either group, yet it's 21% and 25% for these nurses and doctors respectively. That is truly disturbing."

The survey did not ask mothers if they specifically asked for advice, Eisenberg said. Instead, moms were asked to respond "true" or "false" to numerous questions and then followup when appropriate. Here's one example:

-- My baby's doctor (or health care provider) has given me advice about where my baby should

sleep.

True False (skip to question #81)

-- My baby's doctor (or health care provider) thinks my baby should sleep:

1.Strongly disagree 2 3 4 5 6 7.Strongly agree

--alone in his/her own room

--in a parent's (or other adult's) room in his/her own bed

--in a parent's (or other adult's) bed for part of the night

--in a parent's (or other adult's) bed for the whole night

Eisenberg said pediatricians often spend less time than is ideal with patients — "we're sometimes intersecting with people in such a sliver of their lives." But these findings, she adds, could prompt a conversation about how the "public health community can think about interfacing with these other sources in order to promote child and parent health."

She added one particular takeaway for parents: Get involved in your child's health care. "I would always want parents to feel empowered to ask questions," she said.

Here's more from the NIH news release:

"Earlier studies have shown that new mothers listen to their physicians," said Marian Willinger, Ph.D.., of the Pregnancy and Perinatology Branch at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study. "This survey shows that physicians have an opportunity to provide new mothers with much-needed advice on how to improve infant health and even save infant lives."

African American women, Hispanic women and first time mothers were more likely to receive advice from their physicians than were white women and mothers of two or more children.

"As a physician, these findings made me stop and really think about how we communicate important information to new parents," said...Eisenberg. "We may need to be clearer and more specific in telling new mothers about safe sleep recommendations. From a public health perspective, there is a real opportunity to engage families and the media to promote infant health."

For the Study of Attitudes and Factors Effecting Infant Care Practices, the researchers enrolled new mothers at delivery from 32 hospitals around the country, with 1031 women eventually taking part in the study. The authors asked the women to complete questionnaires when the infant was between 2 and 6 months of age on advice they received from their infant's doctor, birth hospital nurses, their family members, and the news media. In addition to finding out whether or not these sources had provided advice on infant care, the questionnaires sought to determine whether the advice was consistent with the recommendations of practitioner groups.

For example, the American Academy of Pediatrics (AAP) recommends that caregivers always place a baby on his or her back for sleep at night and for naps. The women in the study were asked whether they agreed or disagreed with a series of statements on sleep placement: "The nurses at the hospital where my baby was born think that I should place my baby to sleep on the [back, side or stomach.]" If the women agreed with the statement that the baby should be placed to sleep on his or her back, the researchers classified the response as consistent with the AAP recommendation. Agreement with statements on the other placement positions was considered inconsistent with the recommendation.

When it was given, advice from physicians tended to be consistent with recommendations. However, 10 to 15 percent of the advice given on breastfeeding and pacifier use was not consistent with recommendations, and slightly more than 25 percent was not consistent with recommendations for sleep position or location. Interestingly, of the women who reported physician advice on sleep position that was inconsistent with recommendations, 85 percent reported being advised to place the infant on his or her back and at least one other position--usually the side (which confers increased risk for SIDS relative to back position). In comparison, of the more than 32 percent of mothers reporting family advice regarding infant sleep position that was inconsistent with recommendations, 51 percent had been told to place infants to sleep on their stomach (stomach sleeping has been associated with the greatest increased risk for SIDS).