Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success

Abstract

Introduction:

Hospitals are in a unique position to promote, protect, and support breastfeeding. However, the association between in-hospital events and breastfeeding success within population-based samples has not been well studied.

Materials and Methods:

A stratified (by education and birth weight) systematic sample of 5,770 mothers taking part in the Utah Pregnancy Risk Assessment Monitoring System, 2012–2015, were included. Mothers, 2–4 months postpartum, completed the 82-item questionnaire, including if they had ever breastfed their new baby, and if so, current breastfeeding status. Relationships between in-hospital experiences and breastfeeding termination and duration were evaluated via Poisson and Cox proportional hazard regression models, respectively, adjusting for other in-hospital experiences, maternal age, race/ethnicity, maternal education, marital status, smoking, physical activity, delivery method, pregnancy complications, and length of hospital stay.

Results:

Of all, 94.4% of mothers self-reported breastfeeding initiation, of whom 18.8% had breastfed <2 months, having breastfed on average 3.2 weeks (standard error: 0.07). In fully adjusted models, mothers who reported receiving a pacifier, receiving formula, or had staff help them learn how to breastfeed had a higher prevalence of terminating breastfeeding before 2 months (adjusted prevalence ratio [aPR] = 1.13, 95% confidence interval [CI]: 0.97–1.32; aPR = 1.20, 95% CI: 1.07–1.36; and aPR = 1.25, 95% CI: 1.08–1.34). Conversely, mothers who reported starting and feeding only breast milk in the hospital and receiving a phone number to call for help with breastfeeding had a lower prevalence of breastfeeding termination before 2 months (aPR = 0.72, 95% CI: 0.61–0.86; aPR = 0.57, 95% CI: 0.51–0.64; and aPR = 0.91, 95% CI: 0.80–1.03). Adjusted Cox models showed similar direction of associations.

Conclusions:

Encouraging mothers to exclusively breastfeed in the hospital, and reducing gift packs containing pacifiers and formula, may be key areas United States hospitals can focus on to increase breastfeeding success. Prospective assessment in other geographical regions is needed to corroborate these findings.

Get full access to this article

View all access options for this article.

References

Eidelman

AI.

Breastfeeding and the use of human milk: An analysis of the American Academy of Pediatrics 2012 Breastfeeding Policy Statement. Breastfeed Med, 2012; 7:323–324.

Committee on Health Care for Underserved Women. ACOG committee opinion no. 361: Breastfeeding: Maternal and infant aspects. Obstet Gynecol, 2007; 109:479–480.

Calonge

, Petitti

, DeWitt

, et al. Primary care interventions to promote breastfeeding: US Preventive Services Task Force recommendation statement. Ann Intern Med, 2008; 149:560–564.

World Health Organization and UNICEF. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization, 2003.

Hauk

AAFP releases position paper on breastfeeding. Am Fam Physician, 2015; 91:56–57.

Victora

, Bahl

, Barros

, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet, 2016; 387:475–490.

Dieterich

, Felice

, O'Sullivan

, et al. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am, 2013; 60:31–48.

Sibolboro Mezzacappa

, Endicott

. Parity mediates the association between infant feeding method and maternal depressive symptoms in the postpartum. Arch Womens Ment Health, 2007; 10:259–266.

Godfrey

, Lawrence

. Toward optimal health: The maternal benefits of breastfeeding. J Womens Health (Larchmt), 2010; 19:1597–1602.

10.

Bartick

, Reinhold

. The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics, 2010; 125:e1048–e1056.

11.

Nickel

, Labbok

, Hudgens

, et al. The extent that noncompliance with the ten steps to successful breastfeeding influences breastfeeding duration. J Hum Lact, 2013; 29:59–70.

12.

Declercq

, Labbok

, Sakala

, et al. Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed. Am J Public Health, 2009; 99:929–935.

13.

DiGirolamo

, Grummer-Strawn

, Fein

. Effect of maternity-care practices on breastfeeding. Pediatrics, 2008; 122:S43–S49.

14.

Munn

, Newman

, Mueller

, et al. The impact in the United States of the baby-friendly hospital initiative on early infant health and breastfeeding outcomes. Breastfeed Med, 2016; 11:222–230.

15.

Sipsma

, Jones

, Nickel

. Hospital practices to promote breastfeeding: The effect of maternal age. Birth, 2017; 44:272–280.

16.

Kair

, Colaizy

. Association between in-hospital pacifier use and breastfeeding continuation and exclusivity: Neonatal intensive care unit admission as a possible effect modifier. Breastfeed Med, 2017; 12:12–19.

17.

Pounds

, Shostrom

. Analyzing factors that impact breastfeeding duration in the postpartum period: A secondary analysis of PRAMS data. Breastfeed Med, 2018; 13:335–340.

18.

Chung

, Raman

, Chew

, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Technol Asses (Full Rep), 2007; 153:1–186.

19.

Centers for Disease Control and Prevention. Breastfeeding among US children born 2000–2010, CDC National Immunization Survey. Available at https://cdc.gov/breastfeeding/data/nis_data/index.htm (acccessed July 9, 2018).

20.

Martin

, Hamilton

, Osterman

MJK

, et al. Births: Final Data for 2015. National Vital Statistics Report (vol. 66, no. 1). Hyattsville, MD: National Center for Health Statistics, 2017.

21.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. Pregnancy risk assessment measurement scale (PRAMS). Available at https://cdc.gov/prams/index.htm (accessed July 9, 2018).

22.

Boies

, Vaucher

. ABM clinical protocol #10: Breastfeeding the late preterm (34–36 6/7 weeks of gestation) and early term infants (37–38 6/7 weeks of gestation), second revision 2016. Breastfeed Med, 2016; 11:494–500.

23.

Mathews

, Leerkes

, Lovelady

, et al. Psychosocial predictors of primiparous breastfeeding initiation and duration. J Hum Lact, 2014; 30:480–487.

24.

Wallwiener

, Muller

, Doster

, et al. Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: What is important?. Arch Gynecol Obstet, 2016; 294:455–466.

25.

Spiegelman

, Hertzmark

. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol, 2005; 162:199–200.

26.

Centers for Disease Control and Prevention. Breastfeeding report card: United States. 2018. Atlanta, GA. Available at https://cdc.gov/breastfeeding/data/reportcard.htm (accessed November 11, 2018).

27.

Baby-Friendly

USA.

USA designated baby friendly facilities by state. Available at https://babyfriendlyusa.org/for-parents/find-a-baby-friendly-facility (accessed November 11, 2018).

28.

Vogel

, Hutchison

, Mitchell

. The impact of pacifier use on breastfeeding: A prospective cohort study. J Paediatr Child Health, 2001; 37:58–63.

29.

Howard

, Howard

, Lanphear

, et al. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics, 2003; 111:511–518.

30.

Kramer

, Barr

, Dagenais

, et al. Pacifier use, early weaning, and cry/fuss behavior: A randomized controlled trial. JAMA. 2001; 286:322–326.

31.

Sexton

, Natale

. Risks and benefits of pacifiers. Am Fam Physician, 2009; 79:681–685.

32.

Chantry

, Dewey

, Peerson

, et al. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr, 2014; 164:1339–1345.e5.

33.

Nelson

, Perrine

, Scanlon

, et al. Provision of non-breast milk supplements to healthy breastfed newborns in U.S. hospitals, 2009 to 2013. Matern Child Health J, 2016; 20:2228–2232.

34.

Tender

, Janakiram

, Arce

, et al. Reasons for in-hospital formula supplementation of breastfed infants from low-income families. J Hum Lact, 2009; 25:11–17.

35.

Committee on Nutrition, Section on Breastfeeding, Committee on Fetus and Newborn. Donor human milk for the high-risk infant: Preparation, safety, and usage options in the United States. Pediatrics, 2017; 139 [Epub ahead of print]; DOI: 10.1542/peds.2016-3440.

36.

Meyers

, Turner-Maffei

Improved breastfeeding success through the baby-friendly hospital initiative. Am Fam Physician, 2008; 78:180, 182.