Effect of Maternity-Care Practices on Breastfeeding

Abstract

OBJECTIVE. Our goal was to assess the impact of "Baby-Friendly" hospital practices and other maternity-care practices experienced by mothers on breastfeeding duration.METHODS. This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for Ͼ2 months, with complete data on all variables (n ϭ 1907). Predictor variables included indicators of 6 "Baby-Friendly" practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks.RESULTS. Only 8.1% of the mothers experienced all 6 "Baby-Friendly" practices. The practices most consistently associated with breastfeeding beyond 6 weeks were initiation within 1 hour of birth, giving only breast milk, and not using pacifiers. Bringing the infant to the room for feeding at night if not rooming in and not giving pain medications to the mother during delivery were also protective against early breastfeeding termination. Compared with the mothers who experienced all 6 "Baby-Friendly" practices, mothers who experienced none were ϳ13 times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination.CONCLUSIONS. Increased "Baby-Friendly" hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the "Baby-Friendly" hospital practices measured in this study. Pediatrics 2008;122:S43-S49 B REASTFEEDING PROVIDES MANY benefits to both infants and mothers, including optimal nutrients for infant growth and development, enhancing infants' immunologic defenses, and facilitating mother-infant attachment and mothers' recovery from childbirth. 1,2 However, despite the known benefits of breastfeeding, a substantial proportion of mothers do not breastfeed their infants or breastfeed for Ͻ6 months postpartum. In 2004, 73.8% of US mothers breastfed during the early postpartum period, and 41.5% continued to breastfeed at 6 months postpartum. 3 Although these findings represent a steady increase over the years in the percentage of women breastfeeding, the data still fall short of the national Healthy People 2010 goals of 75% women breastfeeding during the early postpartum period and 50% breastfeeding 6 months postpartum. 4 Certain maternity-care practices in hospital settings have been shown to promote breastfeeding. In particular, the Baby-Friendly Hospital Initiative, a global movement launched in 1991 by the World Health Organization and the United Nations Children's Fund (UNICEF), has been associated with positive breastfeeding outcomes both nationally and internationally. [5][6][7][8][9] This initiative includes ...

Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT

“…[22][23][24][25] There are 2 reasons why our results may differ from previous work. First, our intervention incorporated 3 key structured techniques to reduce any negative impact of formula on breastfeeding: (1) using small, carefully measured volumes of formula, so an infant would not be satiated and demand for breastfeeding would be maintained; (2) using a syringe to prevent the nipple confusion that is associated with a bottle' s nipple; and (3) establishing a clear time frame for terminating formula use.…”

“…First, studies have shown that mothers who feed their infants both by breast and with formula during the birth hospitalization discontinue breastfeeding earlier than mothers who breastfeed exclusively during the birth hospitalization. [22][23][24][25] However, these studies have been observational and might have been confounded by weak prenatal intention to breastfeed. Similarly, mothers who experience problems with initiating breastfeeding, such as poor latch, delayed onset of mature milk production, or nipple pain, might be more likely to use formula and less likely to continue breastfeeding.…”

Evaluating the impact of provider breastfeeding encouragement timing: Evidence from a large population-based study

“…[16][17][18][19][20] In-hospital provider encouragement is a likely outgrowth of Baby-Friendly requirements for staff education, but has not been studied independently to our knowledge. One study found five specific hospital practices-breastfeeding within the first hour, breast milk only, infant rooming-in, no pacifier use, and receipt of a telephone number for use after discharge-increased breastfeeding duration, but did not mention provider encouragement.…”

ABM Clinical Protocol #5: Peripartum Breastfeeding Management for the Healthy Mother and Infant at Term, Revision 2013

“…10,[25][26][27][28][29] Extensive early skin-to-skin contact likely increases the duration of any and exclusive breastfeeding. [27][28][29][30][31][32][33][34][35] Delaying procedures such as weighing, measuring, administering eye prophylaxis as well as vitamin K, up to 6 hours after birth, and the initial bath enhances early parent-infant interaction. 10,36 Infants are to be put close to the breast, as soon after birth as is feasible for both mother and infant, to allow for a latch and feeding, ideally within an hour of birth.…”

“…10,36 Infants are to be put close to the breast, as soon after birth as is feasible for both mother and infant, to allow for a latch and feeding, ideally within an hour of birth. 28,[31][32][33][34][35] This practice is to be initiated in the delivery, operating, or recovery room, and every mother should be instructed in proper breastfeeding technique. 5,10,31,[37][38][39][40][41] (I, II-2, II-3, III) 2.…”