Saturday, October 25, 2008

Effects of maternity care practices on breastfeeding

The October 2008 issue of Pediatrics has a supplement devoted to the topic of breastfeeding. Among the many articles was a study of how maternity care practices affect breastfeeding. The study used recent CDC data on infant feeding practices (Infant Feeding Practices II).

The researchers found a strong association between "Baby-Friendly" practices and longer duration of breastfeeding. Mothers who experienced no Baby-Friendly practices, compared to mothers who received all six that the study examined, were thirteen times more likely to stop breastfeeding early. The most significant practices were initiation of breastfeeding within the baby's first hour of life, giving only breast milk, and not using pacifiers.

Below is the abstract from the study; email me if you'd like the full text of the article.

Effect of Maternity-Care Practices on Breastfeeding
Ann M. DiGirolamo, PhD, MPH, Laurence M. Grummer-Strawn, PhD and Sara B. Fein, PhD.
Pediatrics 122 (2008): S43-S49

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 >2 months, with complete data on all variables (n = 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 13 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.


  1. I think it has more to do with the mother's attitude toward breastfeeding, personally. If you are determined to breastfeed you're more likely to stick with than someone who has the attitude of "I'll give it a try and see how it goes". I don't know that hospitals can do much to change the latter attitude into the former.

    For the record, my son did not nurse for 3 hours after he was born. He wasn't hungry and would not attempt to latch on. When he got hungry, he latched and nursed like a champ. I also had it beaten into my head by the LC that giving him a pacifier would doom the nursing relationship. About 4am on the first night after he'd been screaming for an hour the night nurse gave him one and fell asleep. That also had no effect on nursing.

    Going back to my original point, I'm really not buying that so many things can make or break a nursing relationship so easily.

  2. Well, if you look at the study, this compared outcomes among mothers who all intended to breastfeed at least 6 weeks. It's saying that these things absolutely determine breastfeeding success or failure, but that they do have a measurable effect on how long women, all of whom intended to BF for at least a certain amount of time, actually did so.

  3. oops, should be

    "It's NOT saying that these things absolutely..."

  4. Did the study take into account socioeconomic factors that may have affected breastfeeding duration? If they didn't then that is a glaring flaw. I have known plenty of moms who gave up breastfeeding as soon as their maternity leave was up. You can't compare women who have to go back to work with women who have the luxury to stay at home with their babies when studying the factors that influence nursing duration. It has been shown over and over again that socioeconomic standing is good predictor of breastfeeding rates.

  5. I don't remember off the top of my head; I suggest you take a look at the full text to see if they controlled for such variables. And let me know what you find out.

  6. I tried but it seemed to require payment for the the full text. Do you know where I can read it for free?

  7. I would love to see a study with nurse ratios and breast feeding. The hospital I used to work at had a ratio of one nurse to 3 postpartum moms. So helping breastfeeding all night was no problem. When the nurse has 5-8 Mother baby couplets that need help, that is almost impossible to spend the time you need to help them out.

    About pacifiers. Some kids will suck on anything and have great success. However, if you are a new breast feeder I think it wise to get Breast feeding firmly established before introducing anything if you can swing it.

    The study is a great reminder for L&D nurses to help get the baby to breast in the first hour. Usually folks need or want help with this. L&D nurses are burdened with stupid paperwork. This is where I think the hospital hireing a doula would be helpful. Then if I just flat out cannot do it, the doula could. MY Lc says just getting the baby skin to skin with Mom is helpful for breast feeding.

  8. as a prospective study, not a randomised trial, the study reports factors which are associated with or predictive of breastfeeding outcomes amongst women who self report intention to breastfeed > 2 months. So even if the authors did not account for socioeconomic status (which no doubt they did as they are, as suggested, incredibly predictive of breastfeeding rates) the findings suggest that in addition to self reported intentions to breastfeed, supportive practices in hospitals reinforce the initial intention of women and effect breastfeeding rates measures at 6 weeks.

  9. I think it has a lot to do with staff training as well. I work at a hospital aspiring for Baby-Friendly status right now (NICU), and all nurses train with a lacatation consultant and have a binder to study of information, and we are required to have 18 hours of lactation education. All of the parents are educated on breastfeeding by the nurses, lactation consultant, and the physical therapist, who also teaches breastfeeding and working on the preemie's suck/swallow. There are no formula bags, and the Dr. even "prescribes" skin to skin contact! I've noticed a huge difference between this hospital and the last one I worked, which was not breastfeeding-friendly. Almost every mother here is pumping, as opposed to about 40%.

  10. Finding a breast pump on maternity is an act of God. I think my hospital owns 4 total.

  11. That's amazing! Only the first hospital I was in (I've had four) had a nursery, the babies were expected to share a room, and BF was very encouraged (I also BF all four, for varying lengths of time). I thought a lot of hospitals were doing away with nurseries - I think that would be a HUGE marker in helping women learn to feed their babies on demand.

    Great article, as usual.

  12. Whoops... I wonder if there is a difference in those moms that either homebirth/birthing center birth to those that stay in the hospital? I left the hospital after only a few hours each time (I wanted homebirths, due to issues with the speed of my labor I couldn't have them), and recovering at home also lent to my desire to breastfeed. No one bothering me for no reason at all hours, no nasty dirty hospital rooms, no laying around with nothing to do - I was recovering at home. Just a thought...

  13. Thirteen times? Good Lord Almighty. Even if it's half that... those top three practices should be so easy to achieve as standard of care.

  14. I read about this somewhere else too. It is very interesting. I am trying to learn as much as I can right now. I am a first time mommy to be.


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