Maternity care practices: implications for breastfeeding.
BACKGROUND
Many United States mothers never breastfeed their infants or do so for very short periods. The Baby-Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby-Friendly practices experienced on breastfeeding.


METHODS
A longitudinal mail survey (1993-1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions 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 breastfeeding initiation, introduction of supplements, no rooming-in, not breastfeeding on demand, use of pacifiers), and number of Baby-Friendly practices experienced. The main outcome measure was breastfeeding termination before 6 weeks.


RESULTS
Only 7 percent of mothers experienced all five Baby-Friendly practices. The strongest risk factors for early breastfeeding termination were late breastfeeding initiation and supplementing the infant. Compared with mothers experiencing all five Baby-Friendly practices, mothers experiencing none were approximately eight times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination.


CONCLUSIONS
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 is illustrated by the small proportion of mothers who experienced all five practices measured in this study.
DiGirolamo
A M
AM
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway N.E., Atlanta, GA 30341-3717, USA.
Grummer-Strawn
L M
LM
Fein
S
S
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education; D006293:Health Promotion; D015285:Hospital-Patient Relations; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods; D018743:Perinatal Care / Q000592:standards*; D010564:Personnel, Hospital / Q000193:education / Q000523:psychology; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D014480:United Nations; D014481:United States; D014944:World Health Organization