Maternity care practices: Implications for breastfeeding

Background: Many United Starts mothers never breastfeed their infants or do so for very short periods. The Baby-Friendly Hospital Initiative was devel oped to help make breastfeeding the norm in birthing environments, and cons ists of specific recommendations for maternity care practices. The objectiv e of the current study was to assess the impact of the type and number of B aby-Friendly practices experienced on breastfeeding. Methods: A longitudina l mail survey (1993-1994) was administered to women prenatally through 12 m onths postpartum. The study focused on the 1085 women with prenatal intenti ons to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods. Predictor variables included indicators of the absence of specific Baby-Friendly practices (late breastf eeding initiating, introduction of supplements, no rooming-in, not breastfe eding on demand, use of pacifiers), and number of Baby-Friendly practices e xperienced. The main outcome measure was breastfeeding termination before 6 weeks. Results: Only 7 percent of mothers experienced all five Baby-Friend ly practices. The strongest risk factors for early breastfeeding terminatio n were late breastfeeding initiating and supplementing the infant. Compared with mothers experiencing all five Baby-Friendly practices, mothers experi encing none were approximately eight times more likely to stop breastfeedin g early. Additional practices decreased the risk for early termination. Con clusion: Increased Baby-Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to increase adoption of these practices in illustrated by the small proportio n of mothers who experienced all five practices measured in this study.