The Role of Nurses, Midwives, and Doulas in Breastfeeding Education and Rates: Changes During the COVID-19 Pandemic

Background: 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. 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). Conclusion: 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.