Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Corrine Williams, Sc.D.

Committee Member

Robin Vanderpool, DrPH, CHES

Committee Member

Christina Studts, Ph.D.

Committee Member

Pamela Teaster, PhD


Prenatal care is important to ensure a healthy pregnancy for both a woman and her baby. According to the Mayo Clinic, prenatal care should start as soon as there is a positive pregnancy test and should continue throughout the pregnancy.1 The more prenatal care visits a woman attends, the more opportunities to detect potential problems and offer health education materials to help ensure a healthy pregnancy. Prenatal care visits are also used to discuss what may happen after the woman delivers particularly early infant care and breastfeeding. Mothers who do not receive adequate prenatal care are three times more likely to have a low birth weight baby than mothers who receive adequate prenatal care.2 However, women do not always enter care as early as they should. Women sometimes are unaware they are pregnant and delay the start of prenatal care. According to Pagnini et el., a few reasons women delay starting prenatal care may be due to “day- to-day survival concerns” such as an inconvenience in scheduling of the visit as well as making an effort to attend prenatal visits if they do not understand the importance of receiving care.3 Delays in prenatal care could be due to psychosocial factors and demographic risk factors. Barriers include structural issues such as women traveling a far distance to see a provider, transportation access, as well as “provider care issues.” Provider care issues include a discontinuity of providers demonstrating a lack of communication or lack of trust with a health care provider, and inconveniences such as long waiting periods for appointments and scheduling conflicts.3 Women who receive prenatal care were eight times more likely to initiate and continue to breastfeed.4 Breastfeeding provides protective factors for both mother and baby. Babies who are breastfed are more likely to be healthier than babies who are formula fed, have a lower risk of Sudden Infant Death Syndrome (SIDS), are less likely to suffer from juvenile diabetes, and can have higher IQ scores.5 Benefits for breastfeeding mothers include a reduced risk of 2 osteoporosis, a faster recovery from the pregnancy, a reduced risk of ovarian cancer, and an increased attachment of mother and baby.6 According to the American Cancer Society, breastfeeding has shown some protective factors against breast cancer but the research has varied.7 Because of the frequent feeding schedule for breastfeeding infants, researchers speculate parents may choose to co-sleep with their infants for convenience of feeding, fatigue, and to feel close to their infant.8 Co-sleeping, defined as an individual sharing the same sleep surface with an infant, is a growing concern in the United States. Between 1984 and 2004, the rate of infant mortality attributed to accidental suffocation and strangulation quadrupled from 2.8 to 12.5 deaths per 100,000 live births, often due to co-sleeping. Although the reason for the increase in deaths is unknown, these deaths are completely preventable.9 Parents or caregivers who choose to co-sleep with infants increase the infant’s risk of death by being rolled over on, of suffocation from being smothered by a pillow or blanket, and of SIDS.10 In addition, there is an increased risk of the infant being hurt by becoming trapped between the headboard or footboard and the bedframe.10 Ideally, parents receiving early and regular prenatal care would receive information on the dangers of co-sleeping, and would be less likely to co-sleep with their infants. However, there is little research on whether this issue is addressed systematically during prenatal care, and whether women who receive early or adequate prenatal care are less likely to co-sleep. Given the previous research, this study will explore whether breastfeeding is associated with increased co-sleeping and whether early prenatal care affects the relationship between breastfeeding and co-sleeping. Given that women who receive early prenatal care are more likely to breastfeed, one question is whether this contributes to an increase in co-sleeping with their infants. While prenatal care visits may include information on the dangers of co-sleeping, gaps 3 exist in understanding how new mothers manage both breastfeeding and co-sleeping. The results of this study will inform how health care providers such as pediatric nurse practitioners, obstetricians, midwives, and nurses need to educate mothers on the benefits of breastfeeding, as well as the dangers of co-sleeping with a clear explanation of what co-sleeping is.11

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