Maternity Care Practices and Exclusive Breastfeeding Rates at 1 Month Postpartum
by Anne Eglash MD, IBCLC, FABM
It is well known that many women don’t achieve their intended breastfeeding goals. Based on data from a 2013 Infant Feeding Practices Study II, about 60% of women stop breastfeeding earlier than desired. Although breastfeeding intentions have been found to be similar between non-Hispanic (NH) Black and NH White WIC recipients, NH Blacks are less likely to meet their 1 month intention compared to NH Whites.
The study for this week examined whether experiencing hospital maternity care practices (Baby Friendly steps) that support breastfeeding would impact intended breastfeeding practices at 1 month postpartum, among individuals who were WIC recipients. The researchers chose to measure exclusive breastfeeding at 1 month, because after 1 month postpartum there is an increasing number of other issues that impact lactation.
This research evaluated data from 1080 participants in the WIC Infant and Toddler Feeding Practices Study-II, who gave birth July-November 2013. All participants expressed a prenatal intention to breastfeed exclusively to at least 1 month postpartum. The majority were from racial or ethnic minorities and had a household income ≤ 75% of poverty guideline. Approximately 56% breastfed a previous infant.
The researchers measured breastfeeding behavior via interview at 1 month postpartum, and whether the mothers were exposed to any of 6 Baby-Friendly Steps, including breastfeeding within the first hour after birth, showing mothers how to breastfeed and maintain lactation if separated, not being offered infant supplementation unless medically indicated, rooming-in, breastfeeding on demand, and giving no pacifiers.
The study found that 47% met their intention to exclusively breastfeed their infant at 1 month postpartum. They found that experiencing at least 2 Baby-Friendly steps was associated with an increased likelihood of meeting their breastfeeding intentions at 1 month postpartum, while experiencing all 6 steps was associated with a 76% likelihood of meeting their breastfeeding intentions. Some Baby Friendly Steps were more highly associated with meeting breastfeeding intentions. Which ones? See the question!
- Breastfeeding within the first hour after birth (BFHI Step 4)
- Show mothers how to breastfeed and maintain lactation if separated (BFHI Step 5)
- No food or drinks other than breastmilk unless medically indicated (BFHI Step 6)
- Rooming-in (BFHI Step 7)
- Breastfeeding on demand (BFHI Step 8)
- Giving no pacifiers (BFHI Step 9)
See the Answer
Maternity care practices have been linked with higher chances of meeting abstract breastfeeding intentions, but this relationship has not been examined using national data on US low-income women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Using data from the WIC Infant and Toddler Feeding Practices Study-2 on 1080 women who intended to breastfeed, we estimated risk ratios for associations between (1) each of 6 maternity care practices supportive of breastfeeding (breastfeeding within 1 hour of birth, showing mothers how to breastfeed, giving only breast milk, rooming-in, breastfeeding on demand, no pacifiers), (2) each practice adjusted for all other practices, and (3) total number of practices experienced with whether women met their intention to feed only breast milk at 1 month old. Models were adjusted for demographics.
In adjusted models (1), breastfeeding within 1 hour of birth, giving only breast milk, and no pacifiers were associated with higher likelihood of meeting prenatal breastfeeding intentions. Adjusting for all other practices (2), initiating breastfeeding within 1 hour of birth (risk ratio: 1.3; 95% confidence interval: 1.0–1.6) and giving only breast milk (risk ratio: 4.4; 95% confidence interval: 3.4–5.7) remained associated with meeting breastfeeding intention. There was a dose-response relationship between number of steps experienced and higher likelihood of meeting prenatal breastfeeding intentions (3).
Women who experienced maternity care practices supportive of breastfeeding were more likely to meet their prenatal breastfeeding intentions, underscoring the importance of breastfeeding support during the birth hospitalization in enabling mothers to achieve their breastfeeding goals.
Although exposure to breastfeeding in the first hour, and not giving the newborn any other food or drink were the 2 most effective maternity care interventions, exposure to the other interventions was associated with a higher likelihood of exclusive breastfeeding at 1 month.
According to the authors, this is the first study demonstrating the impact of Baby Friendly Hospital Initiative (BFHI) Steps on meeting breastfeeding intentions among a group of low-income WIC participants. The researchers found that the relationship between exposure to BFHI steps and meeting breastfeeding intentions by 1 month was dose related- the greater the # of steps the mothers experienced, the greater the likelihood of meeting their breastfeeding intentions. Mothers who experienced all 6 steps were 4 times more likely to meet their intentions as compared to those who experienced 0-2 steps.
Currently, 27.47 % of births in the USA occur in Baby Friendly facilities. Increasing the number of hospitals that regularly employ BFHI Step is a proven strategy to reduce racial inequities in breastfeeding rates. This was recently confirmed by the CHAMPS Study published in 2022, which increased the number BFHI certified hospitals in Mississippi from 0 in 2014 to 22 in 2020. The researchers were able to demonstrate a 17% decrease in the disparity of breastfeeding initiation between White and Black dyads.