title: The Impact of Hospital Resources and Availability of Professional Lactation Support on Maternity Care: Results of Breastfeeding Surveys 2009-2014.
abstract: Breastfeeding provides maternal and infant health benefits. Maternity care practices encompassed in the 10 Steps to Successful Breastfeeding are positively associated with improved breastfeeding outcomes. This study assessed changes in maternity care practices and lactation support.
  
  
  
  In 2009, 2011, and 2014, New York (NY) hospitals providing maternity care services were surveyed to assess the implementation of 9 of the 10 Steps to Successful Breastfeeding, professional lactation support, distribution of formula and discharge packs, and patient and hospital barriers to breastfeeding success. Generalized estimating equations were used to evaluate changes over time.
  
  
  
  Surveys were completed by 138/138 (2009), 128/129 (2011), and 125/125 (2014) NY hospitals. During this time period, the percent of hospitals reporting implementation of Steps 2, 4, 6, or 9 increased, and the mean number of 9 steps implemented increased from 4.3 to 5.3. Hospitals distributing formula samples at discharge to breastfeeding mothers decreased significantly from 39 (32%) to 3 (2%). Professional lactation staffing ratios (N/1,000 births) of both International Board Certified Lactation Consultants and Certified Lactation Counselors increased between 2009 and 2011, but then decreased between 2011 and 2014. Reported barriers to breastfeeding support changed, with reductions in mixed messages from staff, but increases in lack of financial resources for breastfeeding support, inadequate prenatal education, mothers not being prepared, and family not being receptive to breastfeeding.
  
  
  
  Between 2009 and 2014, NY hospitals reported increased barriers and a reduction in professional lactation support, which may have contributed to the limited improvements in breastfeeding support.
authors.affiliation: 1 New York State Department of Health, Albany, New York.|2 School of Public Health, University at Albany, State University of New York , Rensselaer, New York.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dennison
authors.affiliation: 1 New York State Department of Health, Albany, New York.
authors.forename: Trang Q
authors.initials: TQ
authors.lastname: Nguyen
authors.affiliation: 1 New York State Department of Health, Albany, New York.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Gregg
authors.affiliation: 1 New York State Department of Health, Albany, New York.
authors.forename: Wei
authors.initials: W
authors.lastname: Fan
authors.affiliation: 1 New York State Department of Health, Albany, New York.
authors.forename: Changning
authors.initials: C
authors.lastname: Xu
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006771:Hospitals, Maternity; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology* / Q000523:psychology; D008427:Maternal Health Services / Q000458:organization & administration; D009035:Mothers / Q000523:psychology; D009518:New York / Q000453:epidemiology; D010353:Patient Education as Topic; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D012944:Social Support
keywords: breastfeeding; client staff ratios; communication barriers; financial support; institutional practices; lactation