Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed

Abstract

Objectives: We sought to assess whether breastfeeding-related hospital practices reported by mothers were associated with achievement of their intentions to exclusively breastfeed.

Methods: We used data from Listening to Mothers II, a nationally representative survey of 1573 mothers who had given birth in a hospital to a singleton in 2005. Mothers were asked retrospectively about their breastfeeding intention, infant feeding at 1 week, and 7 hospital practices.

Results: Primiparas reported a substantial difference between their intention to exclusively breastfeed (70%) and this practice at 1 week (50%). They also reported hospital practices that conflicted with the Baby-Friendly Ten Steps, including supplementation (49%) and pacifier use (45%). Primiparas who delivered in hospitals that practiced 6 or 7 of the steps were 6 times more likely to achieve their intention to exclusively breastfeed than were those in hospitals that practiced none or 1 of the steps. Mothers who reported supplemental feedings to their infant were less likely to achieve their intention to exclusively breastfeed: primiparas (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 2.1, 9.3); multiparas (AOR = 8.8; 95% CI = 4.4, 17.6).

Conclusions: Hospitals should implement policies that support breastfeeding with particular attention to eliminating supplementation of healthy newborns.

FIGURE 1

Hospital support and breastfeeding success among US mothers who gave birth in 2005: Listening to Mothers II. Notes. Hospital practices: (1) staff helped mother get started breastfeeding, (2) staff showed mother how to position baby, (3) staff encouraged feeding on demand, (4) staff directed mothers to community breastfeeding resources, (5) staff did not encourage supplementing breastfeeding with formula or water, (6) staff did not encourage pacifier use, (7) staff did not give out free formula or offers. Differences in fulfillment are statistically significant across numbers of policies (P < .01).