title: A comparison of breastfeeding rates in an urban birth cohort among women delivering infants at hospitals that employ and do not employ lactation consultants.
abstract: OBJECTIVE
  To compare rates of breastfeeding at hospital discharge between facilities that employ and do not employ International Board Certified Lactation Consultants (IBCLCs).
  
  
  METHODS
  This study used a cross-sectional design. Data from 11,525 birth certificates of Philadelphia residents who delivered in 2003 were used. Breastfeeding was assessed using a question included on the Pennsylvania birth record, "Is the infant being breastfed at discharge?" The Philadelphia Department of Public Health's lactation consultants collected information on number of hours worked annually by IBCLCs by facility.
  
  
  RESULTS
  After adjusting for race/ethnicity, education, insurance status, age, marital status, route of delivery, birth weight, and gestational age, delivering in a hospital that employed an IBCLC was associated with a 2.28 (95% confidence interval [CI] =1.98,2.62) times increase in the odds of breastfeeding at hospital discharge. Among women receiving Medicaid, delivering at a hospital that employed IBCLCs was associated with a 4.13 (95% CI =3.22,4.80) times increase in the odds of breastfeeding at hospital discharge.
  
  
  CONCLUSIONS
  The findings presented here identify an association between delivering at a facility that employs IBCLCs and breastfeeding at hospital discharge. As the strength of this association is not negligible, particularly for women on Medicaid, these findings may be used to encourage widespread use of IBCLCs.
authors.affiliation: Family Health Research and Program Development Unit, Texas Department of State Health Services, Austin, USA. bcastrucci@aol.com
authors.forename: Brian C
authors.initials: BC
authors.lastname: Castrucci
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Hoover
authors.forename: Suet
authors.initials: S
authors.lastname: Lim
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Maus
mesh_terms: D001942:Breast Feeding / Q000208:ethnology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003253:Consultants; D003430:Cross-Sectional Studies; D005260:Female; D006293:Health Promotion; D006739:Hospital Administration; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D015143:Philadelphia; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000458:organization & administration*; D000078329:Workforce