Maternity Care Practices: Implications for Breastfeeding

Background: Many United States mothers never breastfeed their infants or do so for very short periods. The Baby‐Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby‐Friendly practices experienced on breastfeeding. Methods: A longitudinal mail survey (1993–1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods. Predictor variables included indicators of the absence of specific Baby‐Friendly practices (late breastfeeding initiation, introduction of supplements, no rooming‐in, not breastfeeding on demand, use of pacifiers), and number of Baby‐Friendly practices experienced. The main outcome measure was breastfeeding termination before 6 weeks. Results: Only 7 percent of mothers experienced all five Baby‐Friendly practices. The strongest risk factors for early breastfeeding termination were late breastfeeding initiation and supplementing the infant. Compared with mothers experiencing all five Baby‐Friendly practices, mothers experiencing none were approximately eight times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination. Conclusion: Increased Baby‐Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to increase adoption of these practices is illustrated by the small proportion of mothers who experienced all five practices measured in this study.     

Breastfeeding Policies and Practices in Canadian Hospitals: Comparing 1993 with 2007

Abstract: Background: The Baby‐Friendly Hospital Initiative (BFHI) promotes the World Health Organization International Code of Marketing of Breast‐milk Substitutes (WHO Code) and the WHO/UNICEF’s Ten Steps to Successful Breastfeeding (Ten Steps). The purpose of this study is to describe and compare maternity hospitals’ adherence to the BFHI in 1993 and 2007 for Canada and for each province and territory. Methods: A survey of all Canadian maternity hospitals was conducted in 1993 and 2007 on routine maternity care practices and policies including infant feeding. Results: The overall response rate was 91 percent (n = 523/572 hospitals) in 1993 and 92 percent (n = 323/353 hospitals) in 2007. Eighty‐two percent (415/507) of hospitals in 1993 and 68 percent (198/292) in 2007 had exclusive contracts with formula companies. Fifty‐eight percent (302/517) of hospitals in 1993 and 90 percent (289/322) in 2007 never gave breastfeeding mothers sample packs containing formula. Fifty‐eight percent (296/507) in 1993 and 85 percent (273/321) in 2007 had written breastfeeding policies (Step 1); 97 percent (503/518) in 1993 and 99 percent (320/322) in 2007 allowed mothers to breastfeed, on cue, whenever the babies indicated an interest 24 hours a day (Step 8); 24 percent (126/519) in 1993 and 64 percent (206/321) in 2007 reported that they did not provide soothers (Step 9); 58 percent (297/513) in 1993 and 68 percent (215/316) in 2007 always offered information on breastfeeding support groups and/or advice at time of discharge (Step 10). Conclusions: In the 14 years separating the two surveys, Canadian maternity hospitals substantially improved their implementation of the WHO Code and their adherence to the WHO/UNICEF Ten Steps. (BIRTH 38:3 September 2011)     

Implementing the WHO/UNICEF Baby Friendly Hospital Initiative

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) together launched the Baby Friendly Hospital Initiative (BFHI) in 1989 to promote, protect and support breastfeeding worldwide. This initiative, created in response to repeated resolutions of World Health Assemblies endorsing the importance of breastfeeding promotion, and approved by member states, including Canada, is designed to create a favourable environment for breastfeeding in maternity hospitals and their associated institutions. The principles underlying the BFHI are summarized in the “ten steps to successful breastfeeding” which form the essential components for breastfeeding supportive practices in any health care facility caring for pregnant, birthing or new mothers.Achieving accreditation as a Baby Friendly Hospital is a lengthy process for most maternity facilities and is fraught with difficulties en route. This article addresses some of the challenges facing health care professionals who seek international accreditation for their organizations as a Baby Friendly Hospital according to WHO/UNICEF standards.     

Association between Intrapartum Interventions and Breastfeeding Duration

Introduction : Few women who reside in Hong Kong exclusively breastfeed, and one‐half stop breastfeeding within the first few months. There is little research in this population on the association between intrapartum interventions and breastfeeding duration. Methods : A sample of 1280 mother‐infant pairs were recruited from the obstetric units of 4 public hospitals in Hong Kong and followed prospectively for 12 months or until the infant was weaned. The outcome variables for this analysis were the duration of any and exclusive breastfeeding. Predictor variables were 4 intrapartum interventions: receipt of opioid pain medication, induction versus spontaneous labor, epidural administration, and mode of birth. We used Cox proportional hazards modeling to assess the impact of intrapartum interventions on the duration of any and exclusive breastfeeding, and we constructed Kaplan‐Meier survival curves to evaluate the cumulative impact of multiple intrapartum interventions on breastfeeding outcomes. Results : Bivariate analysis showed that induction of labor (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.09‐1.41), opioid pain medication (HR, 1.21; 95% CI, 1.06‐1.37), and having an emergency cesarean birth (HR, 1.22; 95% CI, 1.01‐1.48) were associated with a shorter duration of any breastfeeding. Induction of labor (HR, 1.23; 95% CI, 1.08‐1.39) and having an emergency cesarean birth (HR, 1.25; 95% CI, 1.05‐1.51) were associated with a shorter duration of exclusive breastfeeding. After controlling for known confounding variables, there was no longer any association between individual intrapartum interventions and the duration of any or exclusive breastfeeding. The median duration of breastfeeding for participants who experienced a natural birth with no intrapartum interventions was 9 weeks compared with 5 weeks for participants who experienced at least 3 intrapartum interventions. Discussion : Clinicians working with new breastfeeding mothers should focus on providing additional support to mothers who experience a difficult labor and birth with multiple interventions to improve their breastfeeding experiences.     

Baby Friendly Hospital Practices: Cesarean Section is a Persistent Barrier to Early Initiation of Breastfeeding

Background: Documented barriers to the implementation of Step 4 of the Baby Friendly Hospital Initiative, which relates to early initiation of breastfeeding, have not considered the impact of operative intervention in delivery on achievement of the goal. This study was designed to test the hypothesis that hospital practices in the immediate postpartum period that are associated with operative intervention in delivery can affect first mother‐infant contact and initiation of breastfeeding. Methods: In a prospective, longitudinal study, a sociodemographically representative sample of 203 primiparous women was recruited. Participants were interviewed at 2 days postpartum in metropolitan hospitals in Melbourne, Australia, and medical records were inspected. At 8 months postpartum 81 percent of participants completed a postal questionnaire. Three mode‐of‐delivery groups (spontaneous vaginal delivery, instrumentally assisted vaginal delivery and cesarean section) and 4 hospital‐of‐delivery groups (including one accredited Baby Friendly Hospital) were compared. Results: Two way ANOVA revealed that women who had a cesarean section experienced a significant delay in initiating breastfeeding compared with women giving birth vaginally, with or without instrumental assistance (p<0.001). Significant differences in this aspect of care were also observed among hospitals, with the Baby‐Friendly hospital performing significantly better than the other three hospitals (p <0.001). An effect due to mode of delivery alone was demonstrated that could not be abolished by differences in hospital practices (p=0.231). Nevertheless, shorter elapsed time between birth and initiation of breastfeeding was not significantly associated with continuation of breastfeeding at 8 months postpartum (p=0.642). Conclusions: The findings confirmed that cesarean section was a significant barrier to the implementation of Baby Friendly Hospital Initiative Step 4 and that hospital practices were amenable to changes that enabled its implementation regardless of the mode of delivery. (BIRTH 29:2 June 2002)     

Breastfeeding Rates and Hospital Breastfeeding Practices in Canada: A National Survey of Women

Background: The Baby‐Friendly Hospital Initiative was launched by the World Health Organization and UNICEF in 1989 to promote, protect, and support breastfeeding worldwide. The objective of this study was to report breastfeeding rates and adherence to the Baby Friendly Hospital Initiative of the World Health Organization and UNICEF in Canada, as reported by participants in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Methods: Eligible women (n = 8,244) were identified from a randomly selected sample of infants born 3 months before the May 2006 Canadian Census, and stratified by province or territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took approximately 45 minutes and were completed when infants were between 5 and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6,421 women (78% response rate). Nineteen of 309 questions concerned early mother‐infant contact and breastfeeding practices. Results: Breastfeeding intention (90.0%) and initiation (90.3%) rates were high, although exclusive breastfeeding rates at 6 months after birth (14.4%) were lower than desirable. The findings suggested a low adherence to several best practices advocated by the Baby‐Friendly Hospital Initiative. Conclusion: Although breastfeeding initiation rates were relatively high in Canada, exclusive breastfeeding duration fell short of globally recommended standards.     

Hospital Practices that Increase Breastfeeding Duration: Results from a Population‐Based Study

ABSTRACT: Background: A high percentage (83%) of mothers in Colorado initiate breastfeeding; but in keeping with national breastfeeding trends, many of them discontinue breastfeeding within the first few months. The objective of this study was to determine the effects of hospital practices on breastfeeding duration and whether the effects differed based on maternal socioeconomic status. Methods: Pregnancy Risk Assessment Monitoring System data were used to calculate breastfeeding duration rates for all Colorado mothers in 2002 to 2003. Breastfeeding duration rates were determined for recipients of each of nine hospital practices included in the survey compared with rates for nonrecipients. Practices that significantly increased breastfeeding duration rates were combined and then stratified by socioeconomic status. Results: Breastfeeding duration was significantly improved when mothers experienced all five specific hospital practices: breastfeeding within the first hour, breastmilk only, infant rooming‐in, no pacifier use, and receipt of a telephone number for use after discharge. Two‐thirds (68%; 95% CI: 61–75) of mothers who experienced all five successful practices were still breastfeeding at 16 weeks compared with one‐half (53%; 95% CI: 49–56) of those who did not. Breastfeeding duration was improved independent of maternal socioeconomic status. Only one in five mothers (18.7%) experienced all five supportive hospital practices. Mothers who experienced the five supportive hospital practices were significantly less likely to stop breastfeeding due to any of the top reasons given for stopping (p < 0.001). Conclusions: Implementation of the five hospital practices supportive of breastfeeding significantly increased breastfeeding duration rates regardless of maternal socioeconomic status. (BIRTH 34:3 September 2007)     

Perspectives of Hospital‐Based Nurses on Breastfeeding Initiation Best Practices

ObjectiveTo assess the variation in breastfeeding knowledge and practices of registered nurses in hospital women and family‐care units and the informal and formal hospital policies related to the initiation and support of breastfeeding.DesignThis qualitative study employed a focus group approach to solicit perceptions of hospital‐based nurses regarding breastfeeding best practices.SettingEight state hospitals stratified by socioeconomic status (SES) and size served as settings to recruit participants for this study.ParticipantsForty female registered nurses from labor and delivery (n=9), postpartum (n=13), labor and delivery/recovery/postpartum care (LDRP) (n=12) and neonatal intensive care unit (NICU) (n=6) constituted eight focus groups.ResultsThe majority of nurses reported being knowledgeable of evidence‐based best practices related to breastfeeding initiation. However, in non‐Baby Friendly/Baby Friendly Intent (non‐BF/BFI) settings, nurses' knowledge often was not in accordance with current best practices in breastfeeding initiation, and reported hospital policies were not based upon evidence‐based practices. Barriers to best practices in breastfeeding initiation included hospital lactation policies (formal and informal), nurses' limited education in breastfeeding initiation best practices, high rates of surgical delivery, and lack of continuity of care with the transition of responsibility from one nurse to another from labor and delivery to transition care to postpartum care.ConclusionsA significant disparity between nurses' intention to support breastfeeding and their knowledge suggests a need for education based on the World Health Organization Baby Friendly standards for nurses at non‐BF/BFI hospitals. A significant barrier to supporting breastfeeding is lack of hospital policy and inappropriate or outdated policy.     

Breast feeding

Breastfeeding confers multiple benefits to both infants and mothers, with evidence linking breastfeeding to a lower risk of many adverse outcomes including gastroenteritis, respiratory disease, necrotising enterocolitis and otitis media in infants, and a lower risk of breast cancer in mothers. Breastfeeding has also been linked to other health, social and cognitive outcomes including childhood obesity and cognitive development. It is the responsibility of all health professionals to support women during the breastfeeding period, and as part of the NHS Long Term Plan the recommendation that Unicef UK Baby Friendly accreditation occurs across all maternity services and includes a focus on improved support for families with infants in neonatal care. Many mothers are required to use drugs during breastfeeding. Almost all drugs transfer into breast milk and this may carry a risk to a breastfed infant. Factors such as the dose received via breast milk, and the pharmacokinetics and effect of the drug in the infant need to be taken into consideration. Problems should not be overstated however, as many drugs are considered 'safe' during breastfeeding.     

Does exclusive breastfeeding increase after hospital discharge? A Greek study.

To monitor the rate of exclusive breastfeeding in Greek maternity wards and to investigate possible changes in infant-feeding practices during the first month after hospital discharge, the authors questioned 4310 Greek mothers from 7 hospitals on the fourth day postpartum. Odds ratios were calculated to estimate the effects of health system, demographic, psychosocial, and environmental factors. Any breastfeeding and full breastfeeding initiation rates were 85% and 23%, respectively. One month postpartum, the corresponding rates of any and exclusive breastfeeding were 79% and 61%, respectively. Mothers of infants who lacked continuous rooming-in while in the maternity ward (OR, 2.08; 95% CI, 1.27-3.40) and with previous experience of breastfeeding (OR, 1.46; 95% CI, 1.19-1.79) were more likely to reestablish exclusive breastfeeding at home despite the use of supplementation in the maternity ward. It seems women are capable of overcoming supplementation in hospital and can revert to exclusive breastfeeding at home.     

Family members’ infant feeding preferences,maternal breastfeeding exposures and exclusive breastfeeding intentions

BackgroundMaternal breastfeeding intentions are strongly associated with breastfeeding exclusivity and duration. Factors that affect new mothers’ exclusive breastfeeding intentions have not been adequately examined.ObjectiveThe purpose of this study was to examine the association between family member's infant feeding preferences, breastfeeding exposures, and womens’ exclusive breastfeeding intentions.Methods1277 breastfeeding mother-infant pairs were recruited from four public hospitals in Hong Kong. We used multiple logistic and linear regression models to explore the impact of the family members’ infant feeding preferences and breastfeeding exposures on exclusive breastfeeding intentions.Results78.1% mothers reported an intention to exclusively breastfeed, and the median intended duration of exclusive breastfeeding was 26 weeks. The husband's preference for breastfeeding (aOR = 1.67; 95% CI 1.20–2.31), previous breastfeeding experience (aOR = 1.56; 95% CI 1.10–2.23) and attendance at an antenatal breastfeeding class (aOR = 2.09; 95% CI 1.45–3.02) were all strongly associated with higher maternal intention to exclusively breastfeed. For every additional family member who preferred breastfeeding, the odds of intending to exclusively breastfeed increased by 32% (aOR1.32; 95% CI, 1.13–1.55). Similarly, the proportion of participants intending to exclusively breastfeed increased progressively with more breastfeeding exposures.ConclusionsIncluding fathers and other significant family members in antenatal breastfeeding education can help to maximize breastfeeding support for the new mother and encourage new mothers to exclusively breastfeed.     

Determinants of newborn feeding in maternity hospital care. Part II: factors associated with exclusive breast feeding

OBJECTIVES: To study the effects of newborn status and hospital practices on exclusive breast-feeding in a maternity ward. DESIGN: National survey conducted in January 1995 in 427 hospitals. MATERIALS AND METHODS: Data on 11,422 newborns obtained from hospital staff. Statistical analysis was performed using odds ratios (OR), population attributable risks (PAR%) and logistic regression method. RESULTS: The most important factors for supplementation were: caesarean section (OR = 5.3; PAR = 19.0%), first breastfeeding later than 2 h after birth (OR = 5.2; PAR = 41.3%), mother and newborn separation longer than 1 h/24 h (OR = 3.4; PAR = 44.9%). Logistic regression analysis showed that first feeding in 2 hours is the main prognostic factor for exclusive breastfeeding in a maternity ward. CONCLUSIONS: Changes in hospital practices increase the proportion of exclusively breastfeeding infants during stay in the maternity ward.     

In‐Hospital Formula Supplementation of Breastfed Babies: A Population‐Based Survey

Abstract: Background: In‐hospital formula supplementation of breastfed newborns is commonplace despite its negative association with breastfeeding duration. Although several studies have described the use of formula supplementation, few have explored the factors that may be associated with its use. The aim of this study was to explore factors associated with in‐hospital formula supplementation using data from a large Australian population‐based survey. Methods: All women who gave birth in September and October 2007 in two Australian states were mailed questionnaires 6 months after the birth. Women were asked how they fed their baby while in hospital after the birth. Multivariable logistic regression was used to explore specified a priori factors associated with in‐hospital formula supplementation. Results: Of 4,085 women who initiated breastfeeding, 23 percent reported their babies receiving formula supplementation. Breastfed babies had greater odds of receiving formula supplementation if their mother was primiparous (adj. OR = 2.16; 95% CI: 1.76–2.66); born overseas and of non‐English‐speaking background (adj. OR = 2.03; 95% CI: 1.56–2.64); had a body mass index more than 30 (adj. OR = 2.27; 95% CI: 1.76–2.95); had an emergency cesarean section (adj. OR = 1.72; 95% CI: 1.3–2.28); or the baby was admitted to a special care nursery (adj. OR = 2.72; 95% CI: 2.19–3.4); had a birthweight less than 2,500 g (adj. OR = 2.02; 95% CI: 1.3–3.15) or was born in a hospital not accredited with Baby‐Friendly Hospital Initiative (BFHI) (adj. OR = 1.53; 95% CI: 1.2–1.94). Conclusions: The number of factors associated with in‐hospital formula supplementation suggests that this practice is complex. Some results, however, point to an opportunity for intervention, with the BFHI appearing to be an effective strategy for supporting exclusive breastfeeding. (BIRTH 38:4 December 2011)     

Breastfeeding in Bristol: teaching good positioning,and support from fathers and families

OBJECTIVES: to determine whether a specific 'hands-off' breastfeeding technique, based on the physiology of suckling and clinical experience, if taught to mothers in the immediate postnatal period, improves their chances of breastfeeding successfully and reduces the incidence of problems. To investigate the factors associated with breastfeeding at two and six weeks postpartum using logistic regression analysis. DESIGN: a non-randomised prospective cohort phased intervention study. SETTING: subjects recruited from one postnatal ward in St. Michael's Hospital, Bristol from October 1996 to November 1998. PARTICIPANTS: 1400 South Bristol mothers who were breastfeeding on discharge from hospital. Three hundred and ninety-five of these mothers were scored for efficiency of using the breastfeeding technique. INTERVENTION: a 'hands-off' breastfeeding technique was taught to midwives in hospital who subsequently taught mothers in their care. MEASUREMENTS: frequencies of exclusive and 'any breastfeeding' at two and six weeks from questionnaires sent to mothers at home, and incidence of breastfeeding problems. FINDINGS: significant increases were observed in the proportion of mothers exclusively breastfeeding at two weeks (P < 0.001) and six weeks (P=0.02) and in 'any breastfeeding' rates (P=0.005) at two weeks after the technique intervention. The incidence of mothers feeling that they did 'not have enough milk' (perceived milk insufficiency) decreased significantly after the breastfeeding technique had been taught (P=0.02). Logistic regression analysis produced a model which showed that mothers with high scores for the 'hands-off' technique were significantly more likely to be breastfeeding at six weeks compared with those who did not use all the elements of the technique (OR 2.4; CI 1.3, 4.3). Factors associated with continuing to breastfeed at two and six weeks postpartum were also investigated using logistic regression. At two weeks, the significant factors associated with breastfeeding included mothers feeling that they had a 'plentiful milk supply' (OR 3.3; CI 2.1, 5.3), not using a dummy (OR 2.6; CI 1.6, 4.0), not giving the baby any other fluid in hospital (OR 2.4; CI 1.5, 3.8) and receiving enough support for breastfeeding from hospital staff (OR 2.1; CI 1.3, 3.5). By six weeks, in addition to these factors, the encouragement from a supportive partner, other family members and health professionals in enabling women to continue to breastfeed was found to show the largest associations with the maintenance of breastfeeding [(OR 37.2; CI 17.3, 80.2) for all three encouraging (327/817; 40% of breastfeeders) compared with no encouragement (67/817; 8% of breastfeeders)]. CONCLUSIONS: in the immediate postnatal period, if mothers are taught good breastfeeding technique by midwives in a 'hands-off' style, which enables mothers to position and attach their babies for themselves, and which is based on a physiological approach, breastfeeding rates are increased and the incidence of perceived milk insufficiency decreases. Successful breastfeeding in the early weeks was associated both with practices and support in hospital and with factors at home including not using dummies and having a supportive partner, family and health professionals who are encouraging breastfeeding. IMPLICATIONS FOR PRACTICE: teaching mothers how to breastfeed in a 'hands-off' way is important in empowering mothers to 'do it for themselves' and in improving breastfeeding rates. Widespread adoption of consistent good practice is achievable following a brief workshop teaching session. Using the 'breastfeeding score checklist' may help midwives to assess a breastfeed more accurately and determine which aspects need improving. Health professionals should aim to educate all key family members, whenever an opportunity arises both during pregnancy and postnatally, in the benefits of breast milk for babies in the first few months of life and how to encourage and support a mother in the early weeks of breastfeeding.     

Exclusive versus predominant breastfeeding in Italian maternity wards and feeding practices through the first year of life.

Determinants of exclusive versus predominant breastfeeding in the maternity ward and the relationship with later feeding practices were investigated in 1656 mothers who breastfed exclusively or predominantly in the maternity ward. Mothers were interviewed through 12 months postdelivery about feeding practices. Information about the World Heath Organization's (WHO's) 10 steps was collected. At hospital stay, breastfeeding was predominant in 43% of infants. Cesarean section (odds ratio [OR] = 1.75), mother's overweight (OR = 1.74), and non-compliance with the WHO's steps 6 (OR = 1.58), 7 (OR = 1.43), and 8 (OR = 1.76) were determinants of predominant, as opposed to exclusive, breastfeeding. Mothers exclusively, rather than predominantly, breastfeeding in the hospital showed a longer duration of full breastfeeding (mean = 3.6 vs 3.1 months), later introduction of formula (3.8 vs 3.3 months), and lower rate of introduction of formula within 1 month (23% vs 30%). Hospitals need to be compliant with the WHO's steps, and Baby-Friendly Hospital Initiatives should be promoted.     

Implementing Change: Becoming Baby‐Friendly in an Inner City Hospital

The Baby‐Friendly Hospital Initiative of the United Nations Children's Fund and the World Health Organization dramatically raises breastfeeding rates when implemented. To date, only 27 of the 16,000 Baby‐Friendly hospitals worldwide are located in the United States. Barriers to becoming Baby‐Friendly in the United States include the strength of the infant formula industry, suboptimal clinician knowledge, and the need to implement significant change throughout an institution. This paper describes how Boston Medical Center, an inner‐city teaching hospital in Boston with approximately 1800 births per year, overcame numerous obstacles and, in December 1999, became the first Baby‐Friendly hospital in Massachusetts.     

Breastfeeding Patterns of Primiparous Mothers in Hong Kong

Abstract: Background: An understanding of patterns of breastfeeding is necessary for the effective implementation of breastfeeding promotion and intervention programs. In Hong Kong, little current data have been gathered on women's breastfeeding rates. The objective of this study was to determine how patterns of breastfeeding, maternal demographics, and maternal employment affect continuation of breastfeeding in primiparous women in Hong Kong. Method: A longitudinal self‐report survey was used to collect data when first‐time mothers (n = 218) were in the hospital, at 1, 3, 6, 9, and 12 months postpartum, or until they weaned their infant. All data (self‐report survey, demographic data, and follow‐up telephone surveys) were collected in Cantonese and then translated into English. Data were analyzed by determining, first, the influence of individual variables on the length of breastfeeding using a simple Cox regression analysis, and second, by grouping variables according to time sequence and entering them into a Cox regression model in 4 sequential phases. Results: Factors that were significantly associated with continuation of breastfeeding were maternal age (HR = 0.97; p = 0.048); attendance at a prenatal breastfeeding class (HR = 0.69; p = 0.020); intended weeks of breastfeeding (HR = 0.97; p < 0.001); breastfeeding score in hospital (HR = 0.99; p = 0.009); and length of exclusive breastfeeding (HR = 0.93; p < 0.001). Similar results were obtained in the multiphase Cox regression analysis; only the breastfeeding score in hospital became marginally insignificant (p = 0.053) after adjusting for demographics, prenatal, and other immediate postpartum factors. Conclusions: Short periods of exclusive breastfeeding and early supplementation were common in this sample. Unlike previous research, maternal employment was not a statistically significant factor in length of continued breastfeeding. Study findings show that multiple factors influence continued breastfeeding in Hong Kong, suggesting further areas for investigation. Changes in practice may improve continued and exclusive breastfeeding rates. (BIRTH 30:3 September 2003)     

Factors Associated with Low Incidence of Exclusive Breastfeeding for the First 6 Months

ABSTRACT: Background: The identification of factors that are associated with early cessation of exclusive breastfeeding is important for defining strategies for the promotion of exclusive breastfeeding. The objective of this study was to identify the determinants of exclusive breastfeeding cessation before 6 months, including variables that generally receive little attention, such as the influence of grandmothers, breastfeeding technique, and sore nipples. Methods: This prospective study follows a cohort of 220 healthy mother‐baby pairs from birth to 6 months, living in Porto Alegre, Brazil. Data were collected at the maternity unit, during a home visit at 30 days, and by telephone interview at 60, 120, and 180 days. Breastfeeding technique was assessed and breasts examined at the maternity unit and during home visits. Cox regression was employed to estimate the degree of association between the variables and the outcome. Results: The following factors were associated with cessation of exclusive breastfeeding before 6 months: adolescent mother (hazard ratio [HR] = 1.48, 95% CI 1.01–2.17), fewer than six prenatal visits (HR = 1.60, 95% CI 1.10–2.33), use of a pacifier within the first month (HR = 1.53, 95% CI 1.12–2.11), and poor latch‐on (HR = 1.29, 95% CI 1.06–1.58 for each unfavorable parameter). Conclusions: Activities to promote exclusive breastfeeding should be intensified for adolescent mothers and for those whose prenatal care was less than ideal. These activities should reinforce the ill effects of pacifiers and should also include appropriate instruction for these mothers in correct breastfeeding technique. (BIRTH 34:3 September 2007)