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  5. Breastfeeding Knowledge Survey
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Thank you for agreeing to participate in this survey. This survey is being conducted to complete the thesis requirements for Barrett, The Honors College at Arizona State University for Lindsey Constenius.

The purpose of this research project is to examine breastfeeding knowledge of healthcare professionals. This is a research project being conducted by Lindsey Constenius (nursing student), Jennie Bever, PhD, and Lesly Kelly, RN, PhD at Arizona State University. You are invited to participate in this research project because you are a healthcare professional at Banner University Medical Center Phoenix.

Completion of the survey and participation in this research project is voluntary. You may choose not to participate, and you may withdraw at any time without penalty. If you complete the survey you are confirming that you voluntarily consent to participate in this research project and you understand that participation in this project is not a condition of employment at Banner Health. You may complete this survey at work. If you elect to complete the survey on your own time, you will not be paid for your time spent on completing the survey.

The procedure involves filling an online survey that will take approximately 5-10 minutes. Your responses will be confidential and we do not collect identifying information such as your name, email address, or IP address. The survey questions will be about breastfeeding and caring for breastfeeding mothers.

All data is stored in a password protected electronic format. To help protect your confidentiality, the surveys will not contain information that will personally identify you. The results of this study will be used for scholarly purposes only and may be shared with Arizona State University representatives.

If you have any questions about the research study, please contact Jennie Bever, PhD, IBCLC. This research has been approved according to Arizona State University IRB procedures for research involving human subjects.

ELECTRONIC CONSENT: Please select your choice below. 

Selecting the "agree" button below indicates that: 


•You have ready the above information
•You voluntarily agree to participate

•You are at least 18 years of age 



If you do not wish to participate in the research study, please exit the survey now.

 
 
 
 
The following questions are in regard to you, your practice, and the population you care for:
 
 
 
1. Age
 
Less than 30
 
31-40
 
41-50
 
51-60
 
More than 60
 
 
 
2. Sex
 
Female
 
Male
 
 
 
3. Role
 
Physician
 
Registered Nurse
 
Pharmacist
 
Physician Assistant
 
Nurse Practitioner
 
Certified Nurse Midwife (CNM)
 
Resident
 
Medical Student
 
Other
 
 
 
 
4. Specialty
 
Anesthesiology
 
Allergy
 
Dermatology
 
Emergency Medicine
 
Family Medicine
 
Gastroenterology
 
Internal Medicine, Generalist
 
Internal Medicine, Specialist
 
Medical Student
 
Med-Peds
 
Neurology
 
OB
 
Pathology
 
Pediatrics, Generalist
 
Pediatrics, Specialist
 
PM&R (Physical Medicine and Rehabilitation)
 
Psychiatry
 
Radiology
 
Surgery, generalist
 
Surgery, specialist
 
Other
 

 
 
 
5. Years in practice
 
< 5 years
 
6-15 years
 
16-25 years
 
More than 25 years
 
Not applicable
 
 
 
6. What percentage of your patients are mothers of children less than 1 year of age?
 
None
 
Up to 25%
 
25-50%
 
50-75%
 
75-100%
 
 
 
7. What percentage of your patients are children 0-1 year?
 
None
 
Up to 25%
 
25-50%
 
50-75%
 
75-100%
 
 
 
The following questions are in regard to your personal experiences with breastfeeding:
 
 
 
8. How many children have you/your partner given birth to, if any?
   
 
 
 
If you do not have children, please skip to question 12.
9. Were your children breastfed?
 
Yes
 
No
 
 
 
If your children were not breastfeed, please skip to question 12. 10. What was the longest time, in months, that any of your children were breastfed?
   
 
 
 
11. How would you describe your/your partner’s breastfeeding experience?
 
Very positive
 
Somewhat positive
 
Somewhat negative
 
Very negative
 
 
 
Last section, almost done! The following questions are in regard to your knowledge with breastfeeding:
 
 
 
12. Where did you learn about breastfeeding? (please select all that apply)
 
Own experience
 
Medical school
 
Residency
 
Self-directed learning
 
Other, please specify:
 

 
 
 
13. How well do you feel your medical training prepared you to support breastfeeding mothers or their infants?
 
Very poorly
 
Somewhat poorly
 
Somewhat well
 
Very well
 
 
 
14. For patients living in the U.S., in which of the following circumstances of the mother would you recommend the mother stop breastfeeding? (Mark all that apply)
 
Breast abscess
 
HIV
 
Hepatitis B
 
Hepatitis C
 
Methadone use

 
 
 
15. In which of these circumstances of the infant would you advise temporary or permanent breastfeeding discontinuation? (Mark all that apply)
 
Galactosemia
 
Slow weight gain
 
Jaundice
 
Gastroesophageal Reflux
 
Blood in stools

 
 
 
16. Which of the following medications should not be used while breastfeeding? (Mark all that apply)
 
Doxycycline
 
Lithium
 
Sertraline
 
Contrast Dye
 
Iodine-131
 
Prednisone

 
 
 
17. After which of the following procedures should breastfeeding mothers express and discard their breastmilk without feeding it to the infant?
 
Dental Procdures
 
X-Rays
 
CT Scan
 
MRI scan
 
General Anesthesia
 
None of the above

 
 
 
18. Which of these foods should not be consumed by breastfeeding mothers? (Mark all that apply).
 
Coffee
 
Alcohol
 
Spicy foods
 
Raw fish
 
Dairy
 
None of the above

 
 
 
19. In your opinion, how realistic is it for working mothers to continue to breastfeed their infant?
 
Never or almost never
 
Sometimes
 
Often
 
Always or almost always
 
 
 
20. Do you feel that current infant formulas are nutritionally equivalent or nearly equivalent to breast milk?
 
Yes
 
No
 
 
 
21. Do you believe you can have an influence on a mother’s decision to breastfeed her infant or not?
 
Yes
 
No
 
 
 
22. Which of the following do you feel is the primary reason why mothers give up breastfeeding?
 
Baby is not satisfied
 
Pain
 
Lack of support
 
Family pressure
 
Return to work or studies
 
 
 
23. Are you comfortable with mothers who breastfeed their infant in front of you?
 
Not comfortable
 
Somewhat uncomfortable
 
Somewhat comfortable
 
Very comfortable
 
 
 
For the remaining five questions please indicate if the statement is "True" or "False".

24. Increasing a mother’ fluid intake will increase milk production.
 
True
 
False
 
I don't know
 
 
 
25. Breastfeeding has been shown to decrease the incidence of many infectious diseases.
 
True
 
False
 
I don't know
 
 
 
26. Breastfeeding has been shown to decrease the risk of Sudden Infant Death Syndrome (SIDS).
 
True
 
False
 
I don't know
 
 
 
27. Breastfeeding decreases the risk of ovarian and breast cancers in mothers.
 
True
 
False
 
I don't know
 
 
 
28. Breastfeeding is safe to continue in mothers who have active herpes simplex lesions on a breast as long as the child only feeds from the unaffected breast.
 
True
 
False
 
I don't know
 
 
 
Survey Question Answers & References


Below are some of the questions with answers, explanations, and references to review the survey. You may view these answers or select the "Done" button at the bottom of the page to continue to the final page to receive the Amazon gift card.

Question 14: In which of the following circumstances of the mother would you recommend the mother stop breastfeeding? (Mark all that apply).
-Breast abscess
-HIV
-Hepatitis B
-Hepatitis C
-Methadone use

Answer: In the United States, breastfeeding is contraindicated for a mother with HIV. “In the industrialized world, it is not recommended that HIV-positive mothers breastfeed. However, in the developing world, where mortality is increased in non-breastfeeding infants from a combination of malnutrition and infectious diseases, breastfeeding may outweigh the risk of the acquiring HIV infection from human milk” (American Academy of Pediatrics [AAP], 2012, p. 832; World Health Organization [WHO], 2010). It is not necessary for breastfeeding to be stopped during a breast abscess, hepatitis B, hepatitis C, or methadone use (AAP, 2012; Amir, 2014; Centers for Disease Control and Prevention [CDC], 2015; CDC, 2015b).


Question 15: In which of these circumstances of the infant would you advise temporary or permanent breastfeeding discontinuation? (Mark all that apply)
-Galactosemia
-Slow weight gain
-Jaundice
-GERD
-Blood in stools

Answer: Breastfeeding is contraindicated for infants diagnosed with galactosemia (CDC, 2015b). Discontinuation of breastfeeding is not advised for slow weight gain, jaundice, GERD or if the infant has blood in stools (AAP, 2012; CDC, 2015a).

Question 16: Which of the following medications should not be used while breastfeeding? (Mark all that apply)
Doxycycline
Lithium
Sertraline
Contrast Dye
Iodine-131
Prednisone

Answer: Iodine-131 is not safe to use while breastfeeding (U.S. National Library of Medicine [NLM], 2015b). Data on lithium use while breastfeeding is mixed. Some sources indicate lithium may be used in mothers of healthy full term infants who are willing and able to monitor their infants, with close pediatric follow up and laboratory monitoring (NLM, 2015d). Please see LactMed references for full details when working with breastfeeding mothers using lithium therapy. Most medications are safe while breastfeeding. For a publicly available searchable database of medication use in breastfeeding mothers, see the US National Library of Medicine’s Lactmed website or app: http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm. See specific medication references below (AAP, 2001; Armstrong, 2008; NLM, 2015).

Question 17: After which of the following procedures should breastfeeding mothers express and discard their breast milk without feeding it to the infant?
-Dental procedures
-X-Rays
-CT scan
-MRI
-General anesthesia
-None of the above

Answer: Dental procedures, x-rays, CT scans, MRIs, and general anesthesia have no known effect on breast milk and are considered safe for use during lactation (American Association of Nurse Anesthetists, 2012; NLM, 2015e; NLM, 2015h; Newman, 2007).

Question 18: Which of these foods should not be consumed by breastfeeding mothers? (Mark all that apply).
-Coffee
-Alcohol
-Spicy foods
-Raw fish
-Dairy
-None of the above

Answer: Alcohol intake is not contraindicated in breastfeeding. The AAP (2012), suggests minimizing intake to no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz. liquor, 8 oz. wine, or 2 beers. Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk. Furthermore, raw fish does not pose the same risk to the breastfeeding infant as it would to a pregnant mother (AAP, 2012). Coffee is also acceptable in moderation while breastfeeding. The recommended upper limit is 300 mg of caffeine, which is the amount of caffeine found in 16 ounces or 2 cups of coffee (NLM, 2015).

Question 24: Increasing a mother’ fluid intake will increase milk production.

False, “There is not enough evidence to support an increased fluid intake beyond what breastfeeding mothers are likely to require to meet their physiological needs” (Ndikom, C.M., Fawole, B., & Ilesanmi, R.E., 2014, p. 6)

Question 25: Breastfeeding has been shown to decrease the incidence of infectious diseases.

True, According to the AAP (2012), the risk for respiratory infections in infants breastfed exclusively is reduced by 72%. In infants who exclusively breastfed for 6 months, cold, ear, and throat infections were similarly decreased by 63%. Furthermore, the risk for gastrointestinal tract infections is decreased by 64% in breastfeeding infants (AAP, 2012).

Question 26: Breastfeeding has been shown to decrease the risk of Sudden Infant Death Syndrome (SIDS).

True, Both partial and exclusive breastfeeding reduces the risk of SIDS by 36%. (AAP, 2012).

Question 27: Breastfeeding decreases the risk of ovarian and breast cancers in mothers.

True, “A cumulative duration of breastfeeding of longer than 12 months is associated with a 28% decrease in breast and ovarian cancer” (AAP, 2012, p. 832).

Question 28: Breastfeeding is safe to continue in mothers who have active herpes simplex lesions on a breast as long as the child only feeds from the unaffected breast.

True, breastfeeding is safe to continue in mothers who have active herpes simplex lesions on a breast as long as the child only feeds from the unaffected breast, or the mom expresses her milk for the infant (AAP, 2012).


References

American Academy of Pediatrics [AAP]. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), 600-603. Retrieved from https://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf

American Academy of Pediatrics [AAP]. (2001). The transfer of drugs and other chemicals into human milk. Pediatrics, 108(3), 776-1029. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/108/3/776.full.pdf.

American Association of Nurse Anesthetists. (2012). Does anesthesia affect a new mom’s ability to breastfeed? Retrieved from http://www.aana.com/newsandjournal/News/Pages/101812Does-Anesthesia-Affect-a-New-Mom’s-Ability-to-Breastfeed.aspx

Armstrong, C. (2008). ACOG guidelines on psychiatric medication use during pregnancy and lactation. American Academy of Family Physicians, 78(6), 772-778. Retrieved from http://www.aafp.org/afp/2008/0915/p772.html.

Amir, L.H., & The Academy of Breastfeeding Medicine Protocol Committee. (2014). ABM Clinical Protocol #4: Mastitis. Breastfeeding Medicine, 9(5), 239-243. Retrieved from http://www.bfmed.org/Media/Files/Protocols/2014_Updated_Mastitis6.30.14.pdf.

Centers for Disease Control and Prevention [CDC]. (2015). Hepatitis B and C infections. Retrieved from http://www.cdc.gov/breastfeeding/disease/hepatitis.htm

Centers for Disease Control and Prevention [CDC]. (2015a). Jaundice. Retrieved from http://www.cdc.gov/breastfeeding/disease/jaundice.htm

Centers for Disease Control and Prevention [CDC]. (2015b). When should a mother avoid breastfeeding? Retrieved from http://www.cdc.gov/breastfeeding/disease/

Newman, J. (2007). Breastfeeding and radiologic procedures. Canadian Family Physician, 53(4), 630-631. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1952588/

Ndikom, C.M., Fawole, B., & Ilesanmi, R.E. (2014). Extra fluids for breastfeeding mothers for increasing milk production. Cochrane Database of Systemic Reviews, 6, 1-17. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24916640.

U.S. National Library of Medicine [NLM]. (2015). Caffeine. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+582.

U.S. National Library of Medicine [NLM]. (2015a). Doxycycline. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+100.

U.S. National Library of Medicine [NLM]. (2015b). Iodine 131. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+670

U.S. National Library of Medicine [NLM]. (2015c). Iodixanol. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+524.

U.S. National Library of Medicine [NLM]. (2015d). Lithium. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+293.

U.S. National Library of Medicine [NLM]. (2015e). Magnetic Resonance Imagery. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+564

U.S. National Library of Medicine [NLM]. (2015f). Prednisone. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+224.

U.S. National Library of Medicine [NLM]. (2015g). Sertraline. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+328.

U.S. National Library of Medicine [NLM]. (2015h). X-rays. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+562.

World Health Organization [WHO]. (2015). Guidelines on HIV and infant feeding. Retrieved from http://apps.who.int/iris/bitstream/10665/44345/1/9789241599535_eng.pdf.

 
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