title: The extent that noncompliance with the ten steps to successful breastfeeding influences breastfeeding duration.
abstract: BACKGROUND, OBJECTIVES: The Ten Steps to Successful Breastfeeding are not, as yet, the norm in the United States. This study examined how noncompliance with each of the Steps, and combinations of 2 Steps, influence duration of breastfeeding at the breast.
  
  
  METHODS
  Data were from the national Infant Feeding Practices Study II. The outcome was duration of any breastfeeding at the breast. Propensity scores modeled the probability of exposure to lacking 1 or more of the Ten Steps. Inverse probability weights controlled for confounding. Survival analyses estimated the relationship between the lack of a Step and breastfeeding duration.
  
  
  RESULTS
  Lack of Step 6 (No human milk substitutes) was associated with shorter breastfeeding duration, compared with being exposed to Step 6 (10.5-wk decrease). Lack of both Steps 4 (Breastfeed within 1 hour after birth) and 9 (Pacifiers), together, was related to the greatest decrease in breastfeeding duration (11.8-wk decrease). The findings supported a dose-response relationship: being exposed to 6 Steps was related to the longest median duration (48.8 wk), followed by 4 or 5 Steps (39.8 wk), followed by 2 or 3 Steps (36.4 wk).
  
  
  CONCLUSIONS
  Prevalent US maternity care practices do not, as yet, include all of the Ten Steps. This lack of care may be associated with poor establishment of the physiological feedback systems that support sustained breastfeeding. Breastfeeding at the breast is compromised when specific combinations of Steps are lacking. Efforts to increase implementation of specific Steps and combinations of Steps may be associated with increased duration of breastfeeding.
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada. Nathan_Nickel@cpe.umanitoba.ca
authors.forename: Nathan Christopher
authors.initials: NC
authors.lastname: Nickel
authors.forename: Miriam H
authors.initials: MH
authors.lastname: Labbok
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.forename: Julie L
authors.initials: JL
authors.lastname: Daniels
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data*; D003657:Decision Making; D019983:Guideline Adherence; D006293:Health Promotion; D006739:Hospital Administration; D006801:Humans; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D013997:Time Factors